Some of the information I give patients concerning the prognosis and outcome of their COPD is based on a landmark study by two researchers, Fletcher and Peto. In 1977 they published an article and a graph depicting the rate of decline in lung function in patients with COPD who smoked and stopped smoking. There was also a second graph, which did not get much attention until recently, which suggested that some patients who have COPD and stopped smoking may not have a progressive decline in lung function. This fact agrees with many observations I have had over the years.
What does this mean to my patients with COPD? I have told everyone that their disease is progressive. The fact may really be that it is not progressive for all. I have many patients whose breathing studies remain unchanged for many years. Keep in mind that the goals of therapy for a COPD patient are: relieve symptoms, keep you out of the hospital, and preserve lung function. The preservation of lung function over time is an important issue and this reassessment of the Fletcher and Peto study may provide some good news to some patients with COPD, namely, despite the fact that they have disease, if they have stopped smoking they may not have significant progression.
These observations will certainly change the information I will give to new patients diagnosed with COPD. It will also allow me the opportunity to give some good news to existing patients as well.