How long you or a loved one can live with chronic obstructive pulmonary disease (COPD) depends on many factors. The good news: Making certain lifestyle changes -- such as quitting smoking -- and getting good medical treatment can reduce COPD's impact on length and quality of life. With good symptom management, many people with COPD, especially those for whom the disease is in the early stages, are able to live comfortably for many years.
Taking a proactive approach to maintaining health and wellness, including following all prescribed medication regimens, participating in pulmonary rehab to maintain activity level, and using oxygen when recommended, can increase both quality of life and life expectancy. Avoiding flares, also called exacerbations, is also important to increasing life expectancy, because acute flares can lead to hospitalization and a greater risk of premature death.
Still, predicting prognosis, or life expectancy, of someone with COPD isn't easy because so many factors can influence the course of the disease. In fact, life expectancy for those with mild COPD is more affected by age, other illnesses, and whether the person is a current smoker than specifically by the COPD itself. The prognosis for someone with advanced COPD is less favorable, but life expectancy is still influenced by a number of considerations.
In general, here's what researchers say you can expect:
Life Expectancy by Stage
Research studies have found that using the stage of COPD by itself isn't an accurate way to predict life expectancy or mortality, particularly at stage I COPD, when symptoms are mild. Because it usually takes years for COPD to progress to more advanced stages, the life expectancy of a person with stage I COPD is mainly affected by other factors. These include smoking status, age, other chronic illnesses, and overall health status.
Still, one group of researchers recently used epidemiological data to estimate life expectancy by stage of COPD.
They concluded that for otherwise healthy 65-year-old men with stage I COPD, life expectancy ranges from 14 to 18 years, depending on whether the person is a current smoker, former smoker, or never smoked. For otherwise healthy 65-year-old women with stage I COPD, life expectancy ranges from 17.2 to 20.5 years. These stage I life expectancies are only slightly shorter than for people without COPD.
For stage 2 COPD, the researchers calculated that life expectancy ranges from 12.1 years (current smokers) to 17.1 years (never a smoker) in men. For women, the numbers ranged from 15.2 to 19.3 years.
For stage 3 or 4 COPD, the researchers calculated that life expectancy ranges from 8.5 to 16.5 years in men, and 11.3 to 18.4 years in women. Again, these numbers are life expectancy for otherwise healthy 65 year-olds, and the range reflects whether the person currently smoked, used to smoke, or never smoked.
Keep in mind that the participants studied were men and women who'd already reached the age of 65, so the years of life expectancy, when added to 65, are encouraging. These numbers would not necessarily apply to someone who was diagnosed with COPD in their 50s or early 60s.
Life Expectancy by BODE Index
Doctors can usually make better predictions regarding life expectancy when they incorporate additional information related to a person's health. One popular model (known as BODE) assigns points based on FEV1 (the amount of air that can be forcibly exhaled from the lungs in the first second of a forced exhalation), body mass index, the distance a person can walk in six minutes, and how short of breath the person usually feels. Worse symptoms correspond to a higher score, with the maximum possible score being 10. This score corresponds to the likelihood that a person will live four years or more.
Someone who scores 0-2 points has an 80 percent likelihood of living four years or more. (Note: More is important here; this test uses four years as a minimum.) Someone who scores 3-4 points has a 67 percent chance of living four years or more, a score of 5-6 translates as a 57 percent likelihood, and a score of 7-8 points suggests an 18 percent likelihood of living four years or more. If you're concerned about prognosis, ask your doctor about using the BODE scoring method to obtain more information, but be aware that this score doesn't predict beyond four years, and many people with fewer symptoms live with COPD much longer than that.
Life Expectancy After Hospitalization
Acute flares and other medical problems often quickly land a person with COPD in the hospital or in the ICU. Several research studies have followed patients for a period of time after these hospitalizations in an effort to predict life expectancy.
In-hospital death rates range between 4 percent and 30 percent overall, depending on the type of COPD patient in the study. Hospital death rates are much higher for those who are sick enough to go to the ICU: around 25 percent.
Death rates during the year after being hospitalized for a COPD flare have been estimated at 30 percent to 40 percent. For those who survived the ICU, about 50 percent to 60 percent died within a year.
To try to estimate longer-term impact of an acute flare that leads to hospitalization, researchers have used the two-year survival rate as an indicator. (But keep in mind this means at least two years; they followed patients for two years but not necessarily longer than that, and many people live longer.) According to these studies, 50 to 60 percent of those hospitalized lived for at least two years afterward, and 42 percent of those who'd been in the ICU lived at least two years.
People with COPD often die of other causes, although there's a good chance their deaths will be related to COPD. In one three-year study of more than 6,000 people with moderate-to-severe COPD, the overall death rate was almost 15 percent. Of the deaths, 35 percent involved a breathing problem, 27 percent were cardiovascular (meaning heart or stroke), 21 percent were cancer, and 18 percent were other or "unknown." Overall, 40 percent of deaths were related to COPD.
Sudden death, which usually means a quick and fatal collapse, isn't uncommon in COPD. In the study above, 16 percent of the deaths were sudden deaths.
For those with mild COPD, life expectancy is mainly driven by age, other illness, and whether the person is a current smoker. People at any stage of COPD should focus on quitting smoking if they haven't already done so.
For those who are hospitalized for a COPD exacerbation, there's some chance of dying during the hospitalization, and a fair chance of dying in the one to two years after hospitalization. If you or your loved one have been hospitalized for COPD, you'll want to remain optimistic and hope for the best, while still factoring the COPD into the advance care planning process that is recommended for all older adults.
For those who like calculators and have had pulmonary function tests, the BODE index can provide a sense of how likely a person is to live for at least another four years. It's also a good idea to discuss prognosis and life expectancy with the doctor. If you prefer the doctor to "tell it like it is," let the doctor know this and ask for as much information as he or she can provide. Bear in mind, however, that the best a doctor can usually do is provide a range, rather than an exact number.
Remember, at every stage of COPD, continuing good treatment with medicine and other therapies is essential to minimizing shortness of breath and maximizing quality of life.