Mortality predictors in disabling chronic obstructive pulmonary disease in old age.

OBJECTIVE prospectively to evaluate predictors of mortality in elderly patients with disabling chronic obstructive pulmonary disease. METHODS 137 (69 men) outpatients, aged 60-89 (mean 73) years with symptomatic disabling chronic obstructive pulmonary disease. We collected baseline demographic and physiological data. Subjects completed the Manchester Respiratory Activities of Daily Living Questionnaire, the Brief Assessment Schedule Depression Cards a screening questionnaire for depression, the Breathing Problems Questionnaire measuring quality of life, and the Montgomery Asberg Depression Rating Scale measuring severity of depression. All subjects were followed prospectively and survival and mortality data were confirmed by contacting general practitioners and scrutinising hospital notes at 30 months. RESULTS the mean (standard deviation) of one second forced expiratory volume was 0.89 (0.3) litres. At 30 months, 44 patients (21 men, aged 61-89 [mean 75] years: 32% of the total) had died. Mean (standard deviation) baseline one second forced expiratory volume of those dying was 0.71 (0.2) litres. On logistic regression analysis, predictors of mortality were: Manchester Respiratory Activities Of Daily Living Questionnaire score (odds ratio=0.88, 95% confidence interval=0.80-0.97); pre-bronchodilator one second forced expiratory volume (odds ratio=0.04, confidence interval=0.005-0.32); body mass index (odds ratio=0.87, confidence interval=0.79-0.97); and long term oxygen therapy (odds ratio=3.17, confidence interval=1.04-8.36). Current smoking status, pack-years smoked, depression scores, quality of life scores, co-morbid diseases and social class did not predict mortality. CONCLUSION disability, use of long-term oxygen therapy, pre-bronchodilator lung function and body-mass index were independent predictors of mortality in elderly patients with severe chronic obstructive pulmonary disease.

[1]  D. Kromhout,et al.  Fruit and fish consumption: a possible explanation for population differences in COPD mortality (The Seven Countries Study) , 1998, European Journal of Clinical Nutrition.

[2]  A. Yohannes,et al.  The Manchester Respiratory Activities of Daily Living Questionnaire: Development, Reliability, Validity, and Responsiveness to Pulmonary Rehabilitation , 2000, Journal of the American Geriatrics Society.

[3]  M. Hyland,et al.  Domains, constructs and the development of the breathing problems questionnaire , 1994, Quality of Life Research.

[4]  P. Schnohr,et al.  Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes. , 1990, Thorax.

[5]  A. Yohannes,et al.  A comparison of the Barthel index and Nottingham extended activities of daily living scale in the assessment of disability in chronic airflow limitation in old age , 1998 .

[6]  B. Burrows,et al.  Predictors of mortality in chronic obstructive pulmonary disease. A 15-year follow-up study. , 1979, The American review of respiratory disease.

[7]  J C Jager,et al.  Current and future medical costs of asthma and chronic obstructive pulmonary disease in The Netherlands. , 1999, Respiratory medicine.

[8]  A. Chaouat,et al.  Prognostic factors in COPD patients receiving long-term oxygen therapy. Importance of pulmonary artery pressure. , 1995, Chest.

[9]  J. Carson,et al.  Pulmonary embolism and mortality in patients with COPD. , 1996, Chest.

[10]  A. Ragaz,et al.  Predictors for early mortality in patients with long-term oxygen home therapy. , 1985, Respiration; international review of thoracic diseases.

[11]  J. Vestbo,et al.  Prognostic value of nutritional status in chronic obstructive pulmonary disease. , 1999, American journal of respiratory and critical care medicine.

[12]  M. Manzotti,et al.  Predictors of survival in subjects with chronic obstructive pulmonary disease treated with long-term oxygen therapy. , 1994, Respiration; international review of thoracic diseases.

[13]  K. Ström.  Oral corticosteroid treatment during long-term oxygen therapy in chronic obstructive pulmonary disease: a risk factor for hospitalization and mortality in women. , 1998, Respiratory medicine.

[14]  P. Jones,et al.  Development and validation of a standardized measure of activity of daily living in patients with severe COPD: the London Chest Activity of Daily Living scale (LCADL). , 2000, Respiratory medicine.

[15]  J. Vestbo,et al.  Vital prognosis after hospitalization for COPD: a study of a random population sample. , 1998, Respiratory medicine.

[16]  M. Tancer,et al.  Cognitive impairment and depression predict mortality in medically ill older adults. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[17]  F. Adshead,et al.  BASDEC: a novel screening instrument for depression in elderly medical inpatients. , 1992, BMJ.

[18]  R. Pistelli,et al.  Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. , 1995, The American journal of medicine.

[19]  D. Górecka,et al.  Effect of long-term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moderate hypoxaemia. , 1997, Thorax.

[20]  A. Dirksen,et al.  Reversible and irreversible airflow obstruction as predictor of overall mortality in asthma and chronic obstructive pulmonary disease. , 1999, American journal of respiratory and critical care medicine.

[21]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.