The strongest predictor of all-cause mortality in COPD patients is objectively measured physical activity, surpassing traditional markers like FEV1 (Forced Expiratory Volume in 1 second). Lower physical activity levels and poor exercise capacity (like short 6-minute walk distance) significantly increase mortality risk, even with similar airflow obstruction. Other important factors include body mass index (BMI), dyspnea (shortness of breath), and the presence of comorbidities, often combined in indices like the BODE index.
The strongest independent predictor of mortality at any age was physical activity which was associated with reduced risk of total, premature and late mortality (range of HRs when comparing the highest vs. the lowest level: 0.24 to 0.48).
Airflow obstruction is associated with increased mortality, even with mild impairment. In mild to moderate COPD, most deaths are due to cardiovascular disease and lung cancer, but as COPD severity increases, respiratory deaths are increasingly common.
A history of exacerbations is the strongest predictor of future exacerbation risk. The risk of re-hospitalisation or death also increases substantially after a first severe COPD exacerbation, and with each subsequent event.
Abbreviation: CAT, COPD Assessment test. Predictors of clinical stability in COPD at two years include higher BMI (p<0.001), higher post-bronchodilator FEV1/FVC ratio (p=0.0132), fewer exacerbations at baseline (p=0.007), absence of concomitant bronchiectasis (p=0.045), and higher hemoglobin levels (p=0.019) (Table 2).
“We know age is a strong predictor, but here we show that physical activity measures are an even better, stronger predictor,” said Cui, an assistant professor at the U School of Public Health. “This makes them one of the strongest predictors of all-cause mortality.”
Current COPD guidelines acknowledge that the following can improve COPD mortality: smoking cessation; long-term oxygen therapy; and lung volume reduction surgery in small subsets of COPD patients.
Smoking: This is the main risk factor for COPD. Three out of four people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke.
Heart failure is very common in people with COPD. Research suggests that 20–70 percent of people with COPD also develop heart failure. The symptoms of heart failure include: shortness of breath.
Previous studies have estimated in-hospital mortality after hospitalisation for a COPD exacerbation to range from 2.5% to 14% 9, 10. Mortality among patients admitted to intensive care units (ICUs) is much higher, i.e. up to 30% 11.
Chronic obstructive pulmonary disease (COPD) is an incurable, progressive illness that is the fourth commonest cause of death worldwide. Death tends to occur after a prolonged functional decline associated with uncontrolled symptoms, emotional distress and social isolation.
In 2022, heart disease, cancer, and accidents were the leading causes of death. Out of the nearly 3.3 million deaths in 2022, over 1.5 million, or 47%, were due to one of these three causes. The fourth, fifth, and sixth most common causes were COVID-19, cerebrovascular diseases, and chronic lower respiratory diseases.
Common signs of COPD exacerbation or flare up:
NHANES 2011-2014: Objective Physical Activity Is the Strongest Predictor of All-Cause Mortality. / Leroux, Andrew; Cui, Erjia; Smirnova, Ekaterina et al. Leroux, Andrew ; Cui, Erjia ; Smirnova, Ekaterina et al. / NHANES 2011-2014 : Objective Physical Activity Is the Strongest Predictor of All-Cause Mortality.
7.1 Indicators of Mortality
Indicators used to measure deaths in a population are crude death rate (CDR), child morality rate, life expectancy at birth, etc. Among the child mortality indicators, the infant mortality rate is widely used as an indicator of health status and development.
Cardiorespiratory fitness, as measured by VO2 max (maximal oxygen uptake), is one of the strongest predictors of overall health and longevity.
Smoking is the main cause of COPD. It is estimated that 90% of people who have COPD are smokers or former smokers. Other factors that contribute to the development and progression of COPD include exposure to second-hand smoke, air pollution, and workplace exposure to dust, smoke, or fumes.
COPD can cause many complications, including: Respiratory infections. People with COPD are more likely to have colds, the flu and pneumonia. Any respiratory infection can make it much harder to breathe and could cause more damage to lung tissue.
Conclusion: COPD patients have significantly higher death risks than non-COPD individuals, worsening with disease severity. Independent determinants of COPD-attributable mortality risk comprise smoking, coexisting respiratory diseases, cardiovascular diseases, and cancer (particularly lung cancer).
Pulmonary Hypertension
It's a common and serious complication of COPD. Symptoms include breathlessness and tiredness that typically get worse with exercise or sleep. Pulmonary hypertension often worsens symptoms and outcomes for people with COPD and shortens lifespan as well.
Your healthcare provider will use your COPD stage to determine your COPD severity and guide your treatment. To stage COPD, your healthcare provider will look at your spirometry or other pulmonary function test results, risk or history of exacerbations, symptoms, and other health conditions.
Respiratory failure is considered the major cause of death in advanced COPD. Comorbidities such as cardiovascular disease and lung cancer are also major causes and, in mild-to-moderate COPD, are the leading causes of mortality.
COPD is often referred to as a "smoker's disease" however although smoking is one of the main risk factors for developing COPD, people who never smoke may also develop COPD. Other risk factors may include: A history of childhood respiratory infections. Smoke exposure from coal or wood burning stove.
Long-term oxygen therapy has also been reported to reduce mortality in patients with severe COPD and hypoxemia, as has pulmonary rehabilitation in patients with severe to very severe COPD.