CHRONIC OBSTRUCTIVE BRONCHOPULMONARY DISEASE .3. FACTORS INFLUENCING PROGNOSIS

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Abstract
One hundred and fifty patients with well-documented chronic obstructive bronchopulmonary disease were observed for 2 to 6 years. Their prognosis was measured by: the observed mortality in excess of a standard U. S. population of the same age and sex, and the loss of exercise tolerance. The cases were divided into numerous groupings to analyze the differences in various clinical, physiologic, and other laboratory findings at the time of initial examination. Findings which appeared to have the greatest adverse influence upon prognosis determined in this way were history of right heart failure, clinical secondary polycythemia, the degree of initial ventilation impairment, degree of abnormality of the arterial blood gases (especially O2), and evidence of right ventricular hypertrophy by the electrocardiogram. Other factors with some adverse effect were absence of evidence of chronic infection, absence of significant improvement in ventilation capacity following inhaled bronchodilator, and impairment of diffusing capacity. Factors with little or no influence were youth at onset of dyspnea, heavy work, coexistence of peptic ulcer, the quantity of smoking prior to onset of dyspnea, mixing efficiency, the measured size of the lung, and O2 ventilation. The value of the electrocardiogram in determining prognosis in this disease was at least as great as that of any other clinical, functional, or laboratory observation. The intimate association of pulmonary hypertension, secondary polycythemia, and right heart failure with chronic severe hypoxia and with a poor prognosis was noteworthy. The prognostic and therapeutic implications of residence at 5,000 feet were discussed. The patients who were persuaded to stop smoking usually noticed marked improvement in cough; these patients then had a better prognosis than those who continued to smoke.

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