Predicting Life Expectancy in People With COPD

4 Factors That Determine Mortality and Survival Rates

man wearing an oxygen mask in the hospital
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The life expectancy of a person with chronic obstructive pulmonary disease (COPD) is a topic that most people would rather not talk about. But if you or a loved one have been diagnosed with the disease, then you've probably spent a great deal of time thinking about it.

And why wouldn't you? Understanding the possible outcome (prognosis) of a disease can often motivate people to make much-needed changes that may improve their quality of life and help them live longer.

In the end, the average life expectancy of persons with COPD — or any disease for that matter — is just that: an average. You can oftentimes exceed expectations by taking charge and addressing those factors that you as an individual can change.

Using the BODE Index to Predict Life Expectancy

While there are no hard-and-fast rules that govern how long a person can live with COPD, a system called the BODE Index has been developed as a means to predict survival times based on four factors outlined the acronym "BODE":

  • "B" is for your body mass index (BMI).
  • "O" is for airflow obstruction as measured by the volume of air expelled.
  • "D" is for severity of dyspnea (shortness of breath),
  • "E" is for tolerance of exercise based on a six-minute walk test.

Based on these factors, a person will be graded on a scale of 0 to 10, with lower grades corresponding to longer survival times and higher grades corresponding to shorter survival times.

With these figures, a clinician can predict what your outcome will be and offer ways to improve upon your BODE grading.

The BODE index estimates the likelihood of you surviving for four years based on the following percentages:

  • 0-2 points: 80 percent
  • 3-4 points: 67 percent
  • 5-6 points: 57 percent
  • 7-10 points: 18 percent

    Breaking Down the BODE Index

    To understand how these factors contribute to mortality in people with COPD, we need to look at each individually within the context of disease progression:

    • Body mass index (BMI) is a tool used measure the amount of body fat you have in relation to your height and weight. Low BMI (being too thin) has been associated with poorer outcome in people with COPD.
    • Airway obstruction is measured by a simple test known as spirometry. One part of the test measures the volume of air you can expel in one second (known as forced expiration volume, or FEV1). FEV1 is a strong predictor of survival in people with COPD. Those with severe airway obstruction on long-term oxygen therapy have low survival rates (roughly 70 percent to year one, 50 percent to year two, and 43 percent to year three).
    • Dyspnea evaluation rates a person's perception of their COPD symptoms and translates those perceptions into a measurable value. The MMRC dyspnea scale grades the disorder on a scale of 0 to 4 (0 being the least breathless to 4 being the most). While FEV1 has been regarded as the best way to predict COPD mortality, the dyspnea level may be more significant when predicting survival.
    • Exercise capacity can be dramatically reduced in the presence of COPD. We can measure this capacity by using a six-minute walk test which can provide us both an estimate of mortality and a baseline by which persons can effect positive lifestyle changes.

      The Best Single Way to Improve Your BODE Grade

      The important thing about the BODE Index is not that it tells long you have to live but what steps you can take to embrace a healthy lifestyle. Chief among these smoking. No other changeable factor has a greater impact on your survival time than the habit of lighting up.

      If you are a smoker with COPD, there are three goals you need to embrace:

      • Quitting smoking is the single most effective (and least expensive) way to either prevent COPD or slow progression of the disease. Lung function decline can stop and even normalize once you quit, irrespective of your age, weight, or gender.
      • Avoiding secondhand smoke means taking steps to not only address your smoking but those around you. There's not point in sitting back politely if the air you breath contains the same carcinogenic fumes.
      • Joining a smoking support group increases your chances of quitting and remaining cigarette-free. Going in alone, even with cessation medications, is simply more difficult as it fails to treat the emotional components of addiction.

      These changes, along with an appropriate, doctor-led exercise program, offers the best means to ensure an improved quality of life if you have COPD.

      Sources:

      Celli, B.; Cote, C.; Marin, J., et al. "The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease.” New Engl J Med. 2004; 350:1005-1012.

      Shavelle, R.; Paculdo, D.; Kush, S.; et al. "Life expectancy and years of life lost in chronic obstructive pulmonary disease: findings from the NHANES III Follow-up Study." Int J Chron Obstruct Pulmon Dis. 2009; 4:137-48.

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