Clinical and functional characteristics of the natural course of COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by a heterogeneous course, which is influenced by many factors. <b>Purpose:</b> to study the factors influencing the nature of the clinical course of COPD in a 15-year observation. <b>Materials:</b> the analysis of the clinical course of COPD for 15 years was carried out at three time control points: at the time of inclusion, after 3 years and after 15 years. Risk factors, respiratory symptoms, dynamics of bronchial obstruction, frequency of exacerbations, comorbid diseases, and cause of death were taken into account. To assess the influence of various factors, the analysis of long-term survival by the Kaplan-Meier method and multivariate analysis by the Cox regression model were performed. <b>Results:</b> the study included 170 male patients with COPD, with an average age of 60.09 ± 1.31 years. The 15-year survival rate was 30%. The analysis showed that the factors that negatively affect the prognosis of patients with COPD were: a three-year rate of decline in FEV1 as a percentage of baseline values (area under the ROC-curve (AUC) - 0.798, p&lt;0.0001), an increase in the frequency of exacerbations of more than 3 per year (Logrank test for the Kaplan-Meier curve: p&lt;0.001; AUC - 0.808, p&lt;0.0001), BMI&lt;21 (Logrank test p&lt;0.05; AUC 0.827, p&lt;0.001), increased severity of dyspnea ( Logrank test p&lt;0.01; AUC 0.737, p&lt;0.001), a history of concomitant atherosclerotic cardiovascular diseases (p&lt;0.05) <b>Conclusion:</b> the nature of the course and prognosis of COPD determines not only the rate of decrease in FEV1, but also factors such as the severity of shortness of breath, the frequency of exacerbations, and the presence of comorbid atherosclerosis.dyspnea, the frequency of exacerbations, and the presence of comorbid atherosclerosis.