Mortality in COPD: Causes, Risk Factors, and Prevention

Figures & data

Table 1.  Causes of death in COPD; data from major clinical trials.

	Cause of death (% of trial participants)
Mean FEV1 (L)	Cardio-vascular	Cancer	Respiratory (non-malignant)	Other	Trial Reference	Study size (n)	Deaths	Study follow-up
2.75^a	22%	54%	8%	16%	LHS III (13)	5887	731	up to 14.5 years
2.54^b	39%	39%	11%	11%	EUROSCOP (14)	1277	18	3 years
1.41^a	32%^c	32%^c	22%	13%^c	ISOLDE (15)	751	68	3 years
1.22^a	26%	21%	35%	18%	TORCH (16, 17)	6184	911	3+ years
1.32^a	16%	22%	39%	23%	UPLIFT (18, 19)	5993	941	4 years + 30 days

Data from large COPD trials suggest that the predominant causes of death in patients with COPD changes with increasing COPD severity, shifting from mostly cancer and cardiovascular deaths in patients with mild to moderate COPD to non-malignant respiratory deaths in patients with severe COPD. Where FEV₁ is the forced expiratory volume in 1 second, ^a = post-bronchodilator value and ^b = pre-bronchodilator value. ^c Percent of deaths attributed to cardiovascular disease (32.4), cancer (32.4), and other causes (13.2%) were rounded down numerically in the table.

Figure 1.  Kaplan-Meier survival curves from the NHANES I study (n = 5542).

Table 2.  Measures that predict all-cause mortality risk in COPD patients.

Predictor	Ref.
FEV1	22, 23
IC/TLC	24
6MWD	25
VO2 max	26
BMI	30–32
Dyspnea Score	27
BODE index	20
Modified BODE index	32, 34
Fibronectin/CRP ratio	41
Exacerbation frequency	35

FEV₁ = forced expiratory volume in 1 second, IC/TLC = inspiratory capacity/total lung capacity, 6MWD = 6-minute walk distance, VO₂max = maximal oxygen uptake, BMI = body mass index, CRP = C-reactive protein.

BODE = body-mass index (B), degree of airflow obstruction (O), degree of functional dyspnea (D), and exercise capacity (E).

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