Many patients, when told they have COPD, will ask about the long term outcome of this disease. In order to answer this question correctly we must know the stage of a patient’s disease. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has helped pulmonary physicians with guidelines that help stage a patient’s level of disease. The initial and long standing guidelines were based on the results of the patient’s breathing tests or pulmonary functions. More recently, a coding system, A B C D, which takes into account the patient’s symptoms such as shortness of breath and their exacerbation history, has helped to more accurately determine where the patient may be in the progression of their disease. The upshot of this analysis should help patients receive the therapy that is appropriate for their stage of disease. Many new medications have been developed to help in a variety of ways.
One thing the guidelines cannot do is improve mortality, even when more or advanced therapy is indicated and prescribed. Patients with COPD need to know that none of the inhaled medications for COPD have been shown conclusively to improve mortality. They relieve symptoms and reduce exacerbations, which can help reduce hospitalizations, but they do not reverse the disease or improve mortality.
Here is the message you need to read and think about: only two things have been shown to improve mortality in patients with COPD: 1) stopping smoking: and 2) using oxygen if they meet predefined levels.