FACTORS AFFECTING PROGNOSIS IN EMPHYSEMA.

Abstract

Factors influencing prognosis in emphysema were investigated in 61 patients. Twenty died and the survivors were followed an average of 36 months. Of the clinical findings on the first visit, only cor pulmonale and weight loss were present significantly more often in the 20 patients who died than in the 41 survivors. Of the pulmonary function studies, only a low diffusing capacity for carbon monoxide (below 59 per cent of normal) and a low maximum breathing capacity (below 30 per cent of normal) were associated with a poor prognosis. The maximum breathing capacity, we feel, has prognostic value because it measures the patient's strength and cooperation in addition to airway obstruction. Diffusing capacity has prognostic value because it reflects destruction of pulmonary tissue. In our data, diffusing capacity is not related to the presence of or development of cor pulmonale, nor is it invariably low in those dying. The effect of uneven ventilation on the measurement of diffusing capacity may explain the conflict between our work and other studies on this relation.