Przewlekła obturacyjna choroba płuc – Rokowania, prognozy i postęp choroby

Przewlekła obturacyjna choroba płuc
Rokowania, prognozy i postęp choroby

Przewlekła obturacyjna choroba płuc (POChP) pozostaje trzecią wiodącą przyczyną zgonów globalnie, z około 3,5 mln zgonów w 2021 roku (5% wszystkich zgonów). Tradycyjnie rokowanie opierało się na spadku FEV₁, jednak obecnie wiadomo, że jest to wieloczynnikowy proces uwzględniający m.in. wiek, choroby współistniejące, stan odżywienia i zaawansowanie choroby. Śmiertelność 5-letnia wynosi około 40% przy FEV₁ 35-55% wartości należnej i wzrasta do 55% przy FEV₁ <35%. Wskaźnik IC/TLC <25% oraz obecność niewydolności serca, niedokrwistości, hiperkapnii czy hipoksemii również pogarszają rokowanie. Wielowymiarowe narzędzia prognostyczne, takie jak indeks BODE (łączący BMI, FEV₁, duszność wg MMRC i dystans w 6-minutowym teście chodu) oraz indeks ADO (wiek, duszność, obturacja), wykazują lepszą predykcję przeżycia niż pojedyncze parametry spirometryczne. Przykładowo, 4-letnie przeżycie według BODE wynosi od 80% (0-2 punkty) do 18% (7-10 punktów).

Prognoza w przewlekłej obturacyjnej chorobie płuc (POChP) – wprowadzenie

Przewlekła obturacyjna choroba płuc (POChP) stanowi poważny globalny problem zdrowotny, będąc trzecią wiodącą przyczyną zgonów na świecie, odpowiadając za około 3,5 miliona zgonów w 2021 roku, co stanowi około 5% wszystkich zgonów globalnie.¹ Ocena prognostyczna pacjentów z POChP jest kluczowa dla właściwego zarządzania przebiegiem choroby, stratyfikacji ryzyka oraz optymalizacji terapii. Przez lata tradycyjnym wykładnikiem progresji choroby był spadek wartości FEV₁ (natężonej objętości wydechowej pierwszosekundowej) w czasie, jednak obecnie wiadomo, że na rokowanie w POChP wpływa wiele różnych czynników.²³

Określenie rokowania w POChP nie jest jednolite i zależy od wielu czynników, takich jak wiek pacjenta, ogólny stan zdrowia, styl życia oraz stadium zaawansowania choroby w momencie diagnozy, a także działań podjętych w celu ograniczenia dalszych uszkodzeń płuc.⁴ Systematyczne badania wykazały szereg niedociągnięć metodologicznych w opracowywaniu modeli prognostycznych, co znajduje odzwierciedlenie w ocenie ryzyka błędu – tylko około jednej czwartej modeli zostało poddanych walidacji wewnętrznej, a zaledwie jedna dziesiąta przeszła walidację zewnętrzną.⁵

Klasyczne wskaźniki prognostyczne w POChP

Wartość prognostyczna FEV₁

Stopień obturacji dróg oddechowych, mierzony za pomocą FEV₁, tradycyjnie stanowi ważny czynnik predykcyjny przeżycia u pacjentów z POChP. Dla pacjentów z FEV₁ w zakresie 35-55% wartości należnej, śmiertelność 5-letnia wynosi około 40%. Natomiast przy FEV₁ poniżej 35% wartości należnej, śmiertelność 5-letnia wzrasta do około 55%.⁶ FEV₁ był przez długi czas wykorzystywany do prognozowania wyników leczenia POChP, jednak obecnie wiadomo, że pomiary FEV₁ oparte są na sztucznym manewrze i nie zawsze korelują z klinicznie istotnymi parametrami, takimi jak duszność, jakość życia, wydolność wysiłkowa czy zaostrzenia.⁷⁸

Inne parametry fizjologiczne

Znaczenie prognostyczne ma również stosunek pojemności wdechowej do całkowitej pojemności płuc (IC/TLC). Ciężko obniżony wskaźnik IC/TLC z wartością progową 25% okazał się predyktorem śmiertelności u pacjentów z POChP.⁹ Ponadto, zaawansowany wiek, obecność chorób serca, niedokrwistość, tachykardia spoczynkowa, hiperkapnia lub hipoksemia prognozują zmniejszone przeżycie, podczas gdy znacząca odpowiedź na leczenie bronchodilatatorami wskazuje na poprawę przeżycia.¹⁰

Wielowymiarowe modele prognostyczne w POChP

Wskaźnik BODE

Odkrycie, że również inne czynniki oprócz FEV₁ odgrywają rolę w określaniu rokowania pacjentów z POChP, doprowadziło do stworzenia wielowymiarowego wskaźnika BODE (wskaźnik masy ciała, obturacja [FEV₁], duszność [zmodyfikowana skala duszności Medical Research Council] i wydolność wysiłkowa [6-minutowy test chodu]).¹¹ Wskaźnik BODE jest jednym z najszerzej walidowanych modeli prognostycznych w POChP.¹²¹³ Indeks ten odzwierciedla wpływ zarówno czynników płucnych, jak i pozapłucnych na rokowanie i przeżycie w POChP.¹⁴

Prognostyka oparta na systemie punktowym BODE wykorzystuje wszystkie 4 czynniki do określenia wyniku:

Wskaźnik masy ciała (BMI): >21 = 0 punktów; <21 = 1 punkt
FEV₁ (% wartości należnej po podaniu bronchodilatatora): >65% = 0 punktów; 50-64% = 1 punkt; 36-49% = 2 punkty; <35% = 3 punkty
Zmodyfikowana skala duszności Medical Research Council (MMRC):
- MMRC 0 = duszność przy intensywnym wysiłku (0 punktów)
- MMRC 1 = duszność przy wchodzeniu na niewielkie wzniesienie (0 punktów)
- MMRC 2 = duszność przy chodzeniu po płaskim terenie, konieczność zatrzymywania się z powodu braku tchu (1 punkt)
- MMRC 3 = duszność po przejściu 100 jardów lub po kilku minutach (2 punkty)
- MMRC 4 = niemożność opuszczenia domu; duszność przy wykonywaniu codziennych czynności (3 punkty)
Dystans w 6-minutowym teście chodu: >350 metrów = 0 punktów; 250-349 metrów = 1 punkt; 150-249 metrów = 2 punkty; <149 metrów = 3 punkty

¹⁵

Przybliżone 4-letnie przeżycie na podstawie powyższego systemu punktowego przedstawia się następująco:

0-2 punkty = 80%
3-4 punkty = 67%
5-6 punktów = 57%
7-10 punktów = 18%

¹⁶

Zastosowanie tego systemu oceny klinicznej potwierdza, że czynniki determinujące rokowanie w POChP pozostają wieloczynnikowe.¹⁷ Im wyższy wynik w skali BODE, tym większe ryzyko zgonu z powodu POChP.¹⁸

Wskaźnik ADO

Indeks ADO (wiek, duszność, obturacja) jest kolejnym wielowymiarowym narzędziem oceny ryzyka w POChP. W 12-letnim badaniu obserwacyjnym porównującym różne systemy oceny ryzyka w przewidywaniu śmiertelności, indeks ADO okazał się najbardziej dokładny, a za nim plasowała się ocena oparta na czynności płuc.¹⁹ Wraz z indeksem BODE, ADO należy do najczęściej walidowanych modeli prognostycznych dla POChP.²⁰

Wskaźnik DOSE

Wskaźnik DOSE (duszność, obturacja, palenie, zaostrzenia) jest kolejnym wielowymiarowym narzędziem prognostycznym wykorzystywanym w ocenie POChP.²¹ Chociaż może być przydatny w praktyce klinicznej, badania wskazują, że indeks ADO oraz ocena oparta na czynności płuc wykazują lepszą dokładność w przewidywaniu śmiertelności.²²

Kluczowe czynniki prognostyczne w POChP

Zaostrzenia choroby

Zaostrzenia POChP wskazują na niestabilność kliniczną i progresję choroby oraz są związane ze zwiększoną zachorowalnością, pogorszeniem chorób współistniejących, obniżoną jakością życia, pogorszeniem funkcji fizycznych i fizjologicznych oraz zwiększonym ryzykiem zgonu.²³ W badaniu dotyczącym opracowania i walidacji modelu prognostycznego do przewidywania 10-letniej śmiertelności u pacjentów z rozpoznaną POChP, stwierdzono, że dwa najważniejsze czynniki ryzyka zgonu to niewydolność serca (HR 1,92; 95% CI 1,87-1,96) oraz aktualne palenie tytoniu (HR 1,68; 95% CI 1,66-1,71).²⁴

Choroby współistniejące

Wieloośrodkowe, prospektywne badanie obserwacyjne z udziałem 201 kolejnych pacjentów z umiarkowaną do ciężkiej POChP wykazało, że oprócz palenia tytoniu, nadciśnienia płucnego i pogarszającej się czynności płuc (znanych czynników ryzyka zgonu u pacjentów z POChP), również rozstrzenie oskrzeli (które są powszechne u pacjentów z umiarkowaną do ciężkiej POChP) są niezależnie związane ze zwiększonym ryzykiem śmiertelności z wszystkich przyczyn. W tym badaniu pacjenci z rozstrzeniami oskrzeli mieli 2,5 razy większe prawdopodobieństwo zgonu niż ci, u których ich nie stwierdzono.²⁵

Śmiertelność w POChP może wynikać z chorób współistniejących (np. chorób układu sercowo-naczyniowego, nowotworów) lub chorób współistniejących, a nie z progresji podstawowego zaburzenia u pacjentów, którzy przestali palić. Śmierć jest zazwyczaj spowodowana ostrą niewydolnością oddechową, zapaleniem płuc, rakiem płuc, chorobą serca lub zatorowością płucną.²⁶

Stan odżywienia

Niedożywienie, często podejrzewane z powodu niskiego wskaźnika masy ciała, jest powszechnym problemem u pacjentów z POChP, a jego częstość występowania waha się od 17% do 47,2%, przy łącznej częstości wynoszącej 30,0%. Łączna częstość występowania ryzyka niedożywienia u pacjentów z POChP wynosi 50,0%.²⁷ Dowody sugerują, że niedożywienie, wykryte za pomocą skali Mini Nutritional Assessment (MNA), jest związane z kilkoma wynikami zdrowotnymi, w tym zachorowalnością i śmiertelnością.²⁸

Badania potwierdzają znaczenie oceny stanu odżywienia u starszych pacjentów z POChP i jej wartość prognostyczną. Im gorszy stan odżywienia, tym wyższe ryzyko. W szczególności MNA może również dostarczyć wartości prognostycznej; osoby zagrożone niedożywieniem lub z jawnym niedożywieniem mają wyższe ryzyko umiarkowanych do ciężkich zaostrzeń.²⁹

Wydolność wysiłkowa

1-minutowy test wstawania z krzesła (1-min STS) i test siły uścisku dłoni zaproponowano jako proste testy funkcjonalnej wydolności wysiłkowej u pacjentów z POChP. Test 1-min STS okazał się silnie związany z długoterminową śmiertelnością (współczynnik ryzyka na 3 powtórzenia więcej: 0,81, 95% CI 0,65 do 0,86) i umiarkowanie związany z długoterminową jakością życia związaną ze zdrowiem (HRQoL).³⁰

Test 1-min STS był statystycznie istotnie związany z 5-letnią śmiertelnością na 3 powtórzenia (współczynnik ryzyka (HR): 0,81, 95% CI 0,65 do 0,86), podczas gdy test siły uścisku dłoni nie był statystycznie istotnie związany ze śmiertelnością. Wyniki te sugerują, że test 1-min STS może być przydatny do oceny stanu zdrowia i długoterminowego rokowania u pacjentów z POChP.³¹

Innowacyjne podejścia prognostyczne w POChP

Uczenie maszynowe i sztuczna inteligencja

Nowoczesne podejścia wykorzystujące uczenie maszynowe i sztuczną inteligencję zyskują na znaczeniu w prognozowaniu przebiegu POChP. DeepSpiro, metoda oparta na głębokim uczeniu do wczesnego przewidywania przyszłego ryzyka POChP, potrafi precyzyjnie prognozować prawdopodobieństwo wystąpienia choroby u niezdiagnozowanych pacjentów wysokiego ryzyka w ciągu najbliższych 15 lat i więcej.³²

Badania pokazują, że sztuczna inteligencja może skutecznie przewidywać długoterminową progresję POChP (p-wartość <0,001).³³ Dostarczając interpretowalne wyniki i przewidując przyszłe ryzyka, DeepSpiro ma potencjał, aby stać się cennym narzędziem wczesnego skryningu, co może pomóc opóźnić progresję choroby i potencjalnie zmniejszyć śmiertelność pacjentów.³⁴

Monitorowanie osobistej jakości powietrza

Innowacyjne podejście do przewidywania zaostrzeń POChP obejmuje wykorzystanie osobistych monitorów jakości powietrza i danych dotyczących stylu życia. Badania wykazały potencjalny wpływ cech środowiskowych na zaostrzenia POChP, przy czym analiza interpretacyjności modelu zidentyfikowała wcześniejsze objawy i skumulowaną ekspozycję na zanieczyszczenia jako kluczowe predyktory zaostrzeń.³⁵

Analiza klastrowa ujawniła obecność dwóch różnych podtypów pacjentów, dla których wydajność modelu różni się znacząco, przy czym klaster 2 to podtyp pacjenta, dla którego przewidywanie zaostrzeń jest bardziej wymagające. W najcięższym podtypie (klaster 2), NO2 był głównym zanieczyszczeniem wpływającym na epizody zaostrzeń, a wcześniejsze zaostrzenia miały również znaczący wpływ na ryzyko zaostrzenia.³⁶

Głównym celem tej metody jest przewidywanie zaostrzeń w krótkim terminie, dostarczanie lekarzom informacji umożliwiających wczesną interwencję. To wczesne ostrzeżenie może skłonić do terminowych interwencji, takich jak dostosowanie leków, zmniejszenie narażenia na czynniki środowiskowe lub zwiększone monitorowanie, potencjalnie zapobiegając wystąpieniu zaostrzeń lub łagodząc ich nasilenie.³⁷

Biomarkery w prognozowaniu POChP

Istnieją podejścia łączące oznaczanie biomarkerów w płynach ustrojowych pacjenta z określeniem co najwyżej trzech z czterech parametrów indeksu BODE i korelujące poziom biomarkera z co najwyżej trzema określonymi wartościami indeksu BODE dla celów prognostycznych, oceny ryzyka, monitorowania terapii i postępowania u pacjentów z POChP.³⁸

Model uwzględniający biomarker był znacząco lepszy niż model wykorzystujący wyłącznie parametry indeksu BODE, a przewidywanie zgonu w ciągu dwóch lat było podobne lub nawet lepsze, gdy biomarker był łączony z co najwyżej trzema parametrami indeksu BODE, zwłaszcza parametrami indeksu BOD lub BD, pomijając parametry indeksu E i/lub O.³⁹

Czynniki wpływające na rokowanie w POChP

Czynniki socjoekonomiczne

Badania pokazują, że POChP jest coraz częściej analizowana pod kątem płci, wieku i statusu socjoekonomicznego. Osoba z POChP, która nie ma dostępu do opieki zdrowotnej i nie ma ubezpieczenia, ma większe prawdopodobieństwo wystąpienia powikłań i wczesnego zgonu, nawet jeśli jej diagnoza jest taka sama jak u osoby o wyższym poziomie dochodów.⁴⁰

Wczesna diagnoza

Wczesna diagnoza może również znacznie poprawić oczekiwaną długość życia pacjentów z POChP.⁴¹ Terminowa i dokładna diagnoza POChP jest kluczowa dla zmniejszenia ryzyka zdrowotnego pacjenta. Nierozpoznanie choroby w tym kluczowym okresie pogorszy jej nasilenie.⁴² Dlatego opracowanie interpretowalnego algorytmu sztucznej inteligencji, który może dokładnie wykryć pacjentów z POChP i wcześnie przewidzieć utajone ryzyko POChP u danej osoby, jest kluczowe dla spowolnienia progresji choroby i zapobiegania śmiertelności pacjentów.⁴³

Zmiany stylu życia

Chociaż POChP jest nieuleczalna, istnieje wiele zmian stylu życia, które można wprowadzić, aby spowolnić progresję choroby i poprawić szanse na dłuższe życie.⁴⁴ POChP nie jest uleczalna, ale objawy mogą się poprawić, jeśli dana osoba unika palenia i narażenia na zanieczyszczenia powietrza oraz otrzymuje szczepionki zapobiegające infekcjom.⁴⁵

Pacjenci wysokiego ryzyka z POChP

Pacjenci o wysokim ryzyku rychłej śmierci to osoby z postępującą niewyjaśnioną utratą masy ciała lub ciężkim pogorszeniem funkcjonowania (np. osoby odczuwające duszność przy samoobsłudze, takie jak ubieranie się, kąpiel lub jedzenie).⁴⁶

Czynniki ryzyka zgonu u pacjentów z ostrym zaostrzeniem wymagającym hospitalizacji obejmują starszy wiek, wyższe PaCO2 i stosowanie doustnych kortykosteroidów w leczeniu podtrzymującym.⁴⁷

Przyszłe kierunki prognozowania w POChP

Przyszłe badania prognostyczne powinny zmierzać w kierunku rekalibracji lub aktualizacji istniejących modeli prognostycznych z dodaniem nowych predyktorów w celu zwiększenia ich wydajności prognostycznej.⁴⁸⁴⁹ Narzędzia prognostyczne o dobrej kalibracji i ważności zewnętrznej powinny informować praktykę kliniczną, a także być zalecane przez wytyczne po przeprowadzeniu badań wpływu w celu zbadania efektu stosowania modelu dla określonego wyniku w praktyce klinicznej.⁵⁰

Istotnym krokiem przed zastosowaniem modeli predykcyjnych w praktyce klinicznej jest ich walidacja zewnętrzna w niezależnych populacjach o różnych cechach klinicznych oraz porównanie wydajności między różnymi modelami predykcyjnymi w celu identyfikacji modeli o najlepszej dyskryminacji i kalibracji.⁵¹⁵²

Włączenie różnych współdziałających czynników do jednego modelu będzie stanowić podstawę dla wzbogacenia doboru pacjentów i poprawy dawkowania racjonalnego w POChP.⁵³ Używając modelu łączonego, wykazano, że płeć, wzrost, nasilenie choroby na początku badania, wcześniejsze stosowanie kortykosteroidów i wskaźniki rezygnacji z badania powinny być brane pod uwagę przy projektowaniu wczesnych badań.⁵⁴

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Materiały źródłowe

#1
https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide, causing 3.5 million deaths in 2021, approximately 5% of all global deaths. […] COPD is not curable but symptoms can improve if one avoids smoking and exposure to air pollution and gets vaccines to prevent infections. […] COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by a breathing test called spirometry, which measures how the lungs are working. […] COPD isn’t curable, but it can get better by not smoking, avoiding air pollution and getting vaccines. […] People living with COPD must be given information about their condition, treatment and self-care to help them to stay as active and healthy as possible.
#2 Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitations | Respiratory Research | Full Text
https://respiratory-research.biomedcentral.com/articles/10.1186/1465-9921-11-79
Current methods for assessing clinical outcomes in COPD mainly rely on physiological tests combined with the use of questionnaires. […] The decline of FEV1 over time has been traditionally used to indicate disease progression. […] FEV1 measurements are based on an artificial manoeuvre and do not always correlate with clinically relevant outcomes such as dyspnoea, health status, exercise capacity, or exacerbations. […] A severely reduced IC/TLC ratio with a threshold value of 25% has been shown to predict mortality in COPD patients. […] Exacerbations of COPD indicate clinical instability and progression of the disease and are associated with increased morbidity, deterioration of comorbidities, reduced health status, physical and physiologic deterioration and an increased risk of mortality.
#3 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonary Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd
Severity of airway obstruction predicts survival in patients with COPD. For an FEV1 35 to 55% predicted, the 5-year mortality is 40%. For an FEV1 less than 35% predicted, the 5-year mortality is 55%. […] More accurate prediction of risk of death is possible by simultaneously measuring body mass index (B), the degree of airflow obstruction (O, which is the FEV1), dyspnea (D, which is measured using the Modified British Medical Research Council (mMRC) Questionnaire), and exercise capacity (E, which is measured with a 6-minute walk test); this is the BODE index. Also, older age and the presence of heart disease, anemia, resting tachycardia, hypercapnia, or hypoxemia predict decreased survival, whereas a significant response to bronchodilators predicts improved survival. Risk factors for death in patients with acute exacerbation requiring hospitalization include older age, higher PaCO2, and use of maintenance oral corticosteroids.
#4 COPD: Whatâs My Life Expectancy?
https://www.webmd.com/lung/copd/features/copd-life-expectancy
Theres no one-size-fits-all answer when it comes to predicting someones life span with COPD. A lot depends on your age, health, lifestyle, and how severe the disease was when you were diagnosed, plus the steps you’ve taken to lessen the damage afterward. […] In general, the higher your number on the GOLD system, the more likely you are to have problems with or even die from COPD. […] The higher your BODE score, the greater your risk for death from COPD. […] Rizzo says more studies are looking at COPD in terms of gender, age, and socioeconomic status. Someone with COPD who doesn’t have access to health care and doesn’t have insurance is more likely to have complications and die early, even if their diagnosis is the same as someone from a higher income level. […] An early diagnosis can also greatly improve your life expectancy. […] While there isn’t a drug to take care of COPD, there are many lifestyle changes you can make that will slow disease progression and improve your chances of living a longer life.
#5 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal
https://pmc.ncbi.nlm.nih.gov/articles/PMC6776831/
Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] Only a quarter of the models were internally validated, and a tenth of the models were externally validated. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimatesâthat is, it informs clinicians how similar the predicted absolute risk is to the true (observed) risk in groups of patients classified in different risk strata. […] The most extensively validated prognostic models were the BODE index and the ADO index. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration.
#6 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonary Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd
Severity of airway obstruction predicts survival in patients with COPD. For an FEV1 35 to 55% predicted, the 5-year mortality is 40%. For an FEV1 less than 35% predicted, the 5-year mortality is 55%. […] More accurate prediction of risk of death is possible by simultaneously measuring body mass index (B), the degree of airflow obstruction (O, which is the FEV1), dyspnea (D, which is measured using the Modified British Medical Research Council (mMRC) Questionnaire), and exercise capacity (E, which is measured with a 6-minute walk test); this is the BODE index. Also, older age and the presence of heart disease, anemia, resting tachycardia, hypercapnia, or hypoxemia predict decreased survival, whereas a significant response to bronchodilators predicts improved survival. Risk factors for death in patients with acute exacerbation requiring hospitalization include older age, higher PaCO2, and use of maintenance oral corticosteroids.
#7 Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitations | Respiratory Research | Full Text
https://respiratory-research.biomedcentral.com/articles/10.1186/1465-9921-11-79
Current methods for assessing clinical outcomes in COPD mainly rely on physiological tests combined with the use of questionnaires. […] The decline of FEV1 over time has been traditionally used to indicate disease progression. […] FEV1 measurements are based on an artificial manoeuvre and do not always correlate with clinically relevant outcomes such as dyspnoea, health status, exercise capacity, or exacerbations. […] A severely reduced IC/TLC ratio with a threshold value of 25% has been shown to predict mortality in COPD patients. […] Exacerbations of COPD indicate clinical instability and progression of the disease and are associated with increased morbidity, deterioration of comorbidities, reduced health status, physical and physiologic deterioration and an increased risk of mortality.
#8 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/297664-overview
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. […] The FEV1 was used to predict outcome in COPD until other factors were identified to play a role in determining the outcome of COPD patients. These discoveries resulted in the creation of the multidimensional BODE index (body mass index, obstruction [FEV1], dyspnea [modified Medical Research Council dyspnea scale], and exercise capacity [6MWD]). […] Prognosis is based on a point system, with all 4 factors used to determine the score, as follows: Body mass index: greater than 21 = 0 points; less than 21 = 1 point; FEV1 (postbronchodilator percent predicted): greater than 65% = 0 points; 50-64% = 1 point; 36-49% = 2 points; less than 35% = 3 points; Modified Medical Research Council (MMRC) dyspnea scale: MMRC 0 = dyspneic on strenuous exercise (0 points); MMRC 1 = dyspneic on walking a slight hill (0 points); MMRC 2 = dyspneic on walking level ground, must stop occasionally due to breathlessness (1 point); MMRC 3 = dyspneic after walking 100 yards or a few minutes (2 points); MMRC 4 = cannot leave house; dyspneic doing activities of daily living (3 points); Six-minute walking distance: greater than 350 meters = 0 points; 250-349 meters = 1 point; 150-249 meters = 2 points; less than 149 meters = 3 points.
#9 Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitations | Respiratory Research | Full Text
https://respiratory-research.biomedcentral.com/articles/10.1186/1465-9921-11-79
Current methods for assessing clinical outcomes in COPD mainly rely on physiological tests combined with the use of questionnaires. […] The decline of FEV1 over time has been traditionally used to indicate disease progression. […] FEV1 measurements are based on an artificial manoeuvre and do not always correlate with clinically relevant outcomes such as dyspnoea, health status, exercise capacity, or exacerbations. […] A severely reduced IC/TLC ratio with a threshold value of 25% has been shown to predict mortality in COPD patients. […] Exacerbations of COPD indicate clinical instability and progression of the disease and are associated with increased morbidity, deterioration of comorbidities, reduced health status, physical and physiologic deterioration and an increased risk of mortality.
#10 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonary Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd
Severity of airway obstruction predicts survival in patients with COPD. For an FEV1 35 to 55% predicted, the 5-year mortality is 40%. For an FEV1 less than 35% predicted, the 5-year mortality is 55%. […] More accurate prediction of risk of death is possible by simultaneously measuring body mass index (B), the degree of airflow obstruction (O, which is the FEV1), dyspnea (D, which is measured using the Modified British Medical Research Council (mMRC) Questionnaire), and exercise capacity (E, which is measured with a 6-minute walk test); this is the BODE index. Also, older age and the presence of heart disease, anemia, resting tachycardia, hypercapnia, or hypoxemia predict decreased survival, whereas a significant response to bronchodilators predicts improved survival. Risk factors for death in patients with acute exacerbation requiring hospitalization include older age, higher PaCO2, and use of maintenance oral corticosteroids.
#11 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/297664-overview
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. […] The FEV1 was used to predict outcome in COPD until other factors were identified to play a role in determining the outcome of COPD patients. These discoveries resulted in the creation of the multidimensional BODE index (body mass index, obstruction [FEV1], dyspnea [modified Medical Research Council dyspnea scale], and exercise capacity [6MWD]). […] Prognosis is based on a point system, with all 4 factors used to determine the score, as follows: Body mass index: greater than 21 = 0 points; less than 21 = 1 point; FEV1 (postbronchodilator percent predicted): greater than 65% = 0 points; 50-64% = 1 point; 36-49% = 2 points; less than 35% = 3 points; Modified Medical Research Council (MMRC) dyspnea scale: MMRC 0 = dyspneic on strenuous exercise (0 points); MMRC 1 = dyspneic on walking a slight hill (0 points); MMRC 2 = dyspneic on walking level ground, must stop occasionally due to breathlessness (1 point); MMRC 3 = dyspneic after walking 100 yards or a few minutes (2 points); MMRC 4 = cannot leave house; dyspneic doing activities of daily living (3 points); Six-minute walking distance: greater than 350 meters = 0 points; 250-349 meters = 1 point; 150-249 meters = 2 points; less than 149 meters = 3 points.
#12 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal
https://pmc.ncbi.nlm.nih.gov/articles/PMC6776831/
Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] Only a quarter of the models were internally validated, and a tenth of the models were externally validated. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimatesâthat is, it informs clinicians how similar the predicted absolute risk is to the true (observed) risk in groups of patients classified in different risk strata. […] The most extensively validated prognostic models were the BODE index and the ADO index. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration.
#13 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal | The BMJ
https://www.bmj.com/content/367/bmj.l5358
Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimates that is, it informs clinicians how similar the predicted absolute risk is to the true (observed) risk in groups of patients classified in different risk strata. […] The most extensively validated prognostic models were the BODE index and the ADO index. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration. […] Future prognostic research should steer towards recalibration or update of existing prognostic models with the addition of new predictors to enhance their prognostic performance.
#14 Family
https://patents.google.com/patent/EP2823314A1/en
the prognosis and/or risk assessment relates to the risk assessment of mortality within 5 years, more preferred within 4 year, even more preferred within 3 years, even more preferred within 2 years, even more preferred within 1 year, most preferred within 6 months. […] the prognosis and/or risk assessment relates to the risk of the occurrence of acute exacerbations and patients are stratified into either a group of patients likely getting an acute exacerbation or into a group of patients which do not likely get an acute exacerbation. […] the BODE is a multidimensional index designed to assess clinical risk in people with COPD. […] the BODE index reflects the impact of both pulmonary and extrapulmonary factors on prognosis and survival in COPD.
#15 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/297664-overview
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. […] The FEV1 was used to predict outcome in COPD until other factors were identified to play a role in determining the outcome of COPD patients. These discoveries resulted in the creation of the multidimensional BODE index (body mass index, obstruction [FEV1], dyspnea [modified Medical Research Council dyspnea scale], and exercise capacity [6MWD]). […] Prognosis is based on a point system, with all 4 factors used to determine the score, as follows: Body mass index: greater than 21 = 0 points; less than 21 = 1 point; FEV1 (postbronchodilator percent predicted): greater than 65% = 0 points; 50-64% = 1 point; 36-49% = 2 points; less than 35% = 3 points; Modified Medical Research Council (MMRC) dyspnea scale: MMRC 0 = dyspneic on strenuous exercise (0 points); MMRC 1 = dyspneic on walking a slight hill (0 points); MMRC 2 = dyspneic on walking level ground, must stop occasionally due to breathlessness (1 point); MMRC 3 = dyspneic after walking 100 yards or a few minutes (2 points); MMRC 4 = cannot leave house; dyspneic doing activities of daily living (3 points); Six-minute walking distance: greater than 350 meters = 0 points; 250-349 meters = 1 point; 150-249 meters = 2 points; less than 149 meters = 3 points.
#16 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/297664-overview
The approximate 4-year survival based on the point system above is as follows: 0-2 points = 80%; 3-4 points = 67%; 5-6 points = 57%; 7-10 points = 18%. […] The use of a clinical scoring system reinforces that determinants of prognosis in COPD remain multifactorial. […] In a multicenter, prospective, observational study of 201 consecutive patients with moderate-to-severe COPD, Martinez-Garcia et al reported that in addition to smoking, pulmonary hypertension, and declining lung function (known risk factors for mortality in patients with COPD), bronchiectasis (which is common in patients with moderate-to-severe COPD) is independently associated with increased risk of all-cause mortality. […] In this study, those who had bronchiectasis were found to be 2.5 times more likely to die than those who did not.
#17 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/297664-overview
The approximate 4-year survival based on the point system above is as follows: 0-2 points = 80%; 3-4 points = 67%; 5-6 points = 57%; 7-10 points = 18%. […] The use of a clinical scoring system reinforces that determinants of prognosis in COPD remain multifactorial. […] In a multicenter, prospective, observational study of 201 consecutive patients with moderate-to-severe COPD, Martinez-Garcia et al reported that in addition to smoking, pulmonary hypertension, and declining lung function (known risk factors for mortality in patients with COPD), bronchiectasis (which is common in patients with moderate-to-severe COPD) is independently associated with increased risk of all-cause mortality. […] In this study, those who had bronchiectasis were found to be 2.5 times more likely to die than those who did not.
#18 COPD: Whatâs My Life Expectancy?
https://www.webmd.com/lung/copd/features/copd-life-expectancy
Theres no one-size-fits-all answer when it comes to predicting someones life span with COPD. A lot depends on your age, health, lifestyle, and how severe the disease was when you were diagnosed, plus the steps you’ve taken to lessen the damage afterward. […] In general, the higher your number on the GOLD system, the more likely you are to have problems with or even die from COPD. […] The higher your BODE score, the greater your risk for death from COPD. […] Rizzo says more studies are looking at COPD in terms of gender, age, and socioeconomic status. Someone with COPD who doesn’t have access to health care and doesn’t have insurance is more likely to have complications and die early, even if their diagnosis is the same as someone from a higher income level. […] An early diagnosis can also greatly improve your life expectancy. […] While there isn’t a drug to take care of COPD, there are many lifestyle changes you can make that will slow disease progression and improve your chances of living a longer life.
#19 Prediction of Mortality Using Different COPD Risk Assessments – | COPD
https://www.dovepress.com/prediction-of-mortality-using-different-copd-risk-assessments-ndash-a–peer-reviewed-fulltext-article-COPD
Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices. […] Conclusion: In this 12-year follow-up, out of all risk assessment systems to predict mortality, the ADO index was the most accurate, followed by an assessment by lung function. We conclude that the GOLD recommendation to use lung function for prognosis is appropriate and that the ADO index can be a useful tool for COPD risk assessment in clinical practice.
#20 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal | The BMJ
https://www.bmj.com/content/367/bmj.l5358
Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimates that is, it informs clinicians how similar the predicted absolute risk is to the true (observed) risk in groups of patients classified in different risk strata. […] The most extensively validated prognostic models were the BODE index and the ADO index. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration. […] Future prognostic research should steer towards recalibration or update of existing prognostic models with the addition of new predictors to enhance their prognostic performance.
#21 Prediction of Mortality Using Different COPD Risk Assessments – | COPD
https://www.dovepress.com/prediction-of-mortality-using-different-copd-risk-assessments-ndash-a–peer-reviewed-fulltext-article-COPD
Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices. […] Conclusion: In this 12-year follow-up, out of all risk assessment systems to predict mortality, the ADO index was the most accurate, followed by an assessment by lung function. We conclude that the GOLD recommendation to use lung function for prognosis is appropriate and that the ADO index can be a useful tool for COPD risk assessment in clinical practice.
#22 Prediction of Mortality Using Different COPD Risk Assessments – | COPD
https://www.dovepress.com/prediction-of-mortality-using-different-copd-risk-assessments-ndash-a–peer-reviewed-fulltext-article-COPD
Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices. […] Conclusion: In this 12-year follow-up, out of all risk assessment systems to predict mortality, the ADO index was the most accurate, followed by an assessment by lung function. We conclude that the GOLD recommendation to use lung function for prognosis is appropriate and that the ADO index can be a useful tool for COPD risk assessment in clinical practice.
#23 Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitations | Respiratory Research | Full Text
https://respiratory-research.biomedcentral.com/articles/10.1186/1465-9921-11-79
Current methods for assessing clinical outcomes in COPD mainly rely on physiological tests combined with the use of questionnaires. […] The decline of FEV1 over time has been traditionally used to indicate disease progression. […] FEV1 measurements are based on an artificial manoeuvre and do not always correlate with clinically relevant outcomes such as dyspnoea, health status, exercise capacity, or exacerbations. […] A severely reduced IC/TLC ratio with a threshold value of 25% has been shown to predict mortality in COPD patients. […] Exacerbations of COPD indicate clinical instability and progression of the disease and are associated with increased morbidity, deterioration of comorbidities, reduced health status, physical and physiologic deterioration and an increased risk of mortality.
#24 Development and validation of a multivariable mortality risk prediction model for COPD in primary care
https://pmc.ncbi.nlm.nih.gov/articles/PMC9156666/
Risk stratification of chronic obstructive pulmonary disease (COPD) patients is important to enable targeted management. […] We sought to develop and validate a prognostic model to predict 10-year mortality in patients with diagnosed COPD. […] According to the validated prognostic model, the two most important risk factors of mortality were heart failure (HR 1.92; 95% CI 1.87-1.96) and current smoking (HR 1.68; 95% CI 1.66-1.71). […] The most significant risk factors associated with mortality (with at least a 50% increased risk) after COPD diagnosis were having heart failure and being a current smoker (compared to non-smoker). […] The extended Cox-regression model developed in this study was internally validated and achieved strong validation performance. […] In summary, we have developed and validated a prognostic model to predict the 10-year mortality of patients diagnosed with COPD using national-level, primary care data (the largest study on the topic to date).
#25 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/297664-overview
The approximate 4-year survival based on the point system above is as follows: 0-2 points = 80%; 3-4 points = 67%; 5-6 points = 57%; 7-10 points = 18%. […] The use of a clinical scoring system reinforces that determinants of prognosis in COPD remain multifactorial. […] In a multicenter, prospective, observational study of 201 consecutive patients with moderate-to-severe COPD, Martinez-Garcia et al reported that in addition to smoking, pulmonary hypertension, and declining lung function (known risk factors for mortality in patients with COPD), bronchiectasis (which is common in patients with moderate-to-severe COPD) is independently associated with increased risk of all-cause mortality. […] In this study, those who had bronchiectasis were found to be 2.5 times more likely to die than those who did not.
#26 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonary Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd
Patients at high risk of imminent death are those with progressive unexplained weight loss or severe functional decline (eg, those who experience dyspnea with self-care, such as dressing, bathing, or eating). […] Mortality in COPD may result from comorbidities (eg, cardiovascular disease, cancer) or intercurrent illnesses rather than from progression of the underlying disorder in patients who have stopped smoking. Death is generally caused by acute respiratory failure, pneumonia, lung cancer, heart disease, or pulmonary embolism.
#27 The Impact of Malnutrition on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: The Predictive Value of the Mini Nutritional Assessment (MNA) versus Acute Exacerbations in Patients with Highly Complex COPD and Its Clinical and Prognostic Implications
https://www.mdpi.com/2072-6643/16/14/2303
Chronic obstructive pulmonary disease (COPD) is a major global health problem characterized by persistent airflow limitation and chronic systemic inflammation, with a significant impact on patientsâ overall health and well-being. […] Malnutrition, often suspected because of a low body mass index, is a common problem in COPD patients, with its prevalence ranging from 17% to 47.2% and a pooled prevalence of 30.0%, and the pooled prevalence of being at risk of malnutrition in patients with COPD is 50.0%. […] Evidence suggests that malnutrition, as detected by the MNA score, is associated with several health-related outcomes, including morbidity and mortality. […] Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value. […] The poorer their nutritional status, the higher the risk. […] In particular, the MNA may also provide prognostic value; subjects at risk of malnutrition or with overt malnutrition in our analysis have a higher risk of moderate to severe acute exacerbations.
#28 The Impact of Malnutrition on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: The Predictive Value of the Mini Nutritional Assessment (MNA) versus Acute Exacerbations in Patients with Highly Complex COPD and Its Clinical and Prognostic Implications
https://www.mdpi.com/2072-6643/16/14/2303
Chronic obstructive pulmonary disease (COPD) is a major global health problem characterized by persistent airflow limitation and chronic systemic inflammation, with a significant impact on patientsâ overall health and well-being. […] Malnutrition, often suspected because of a low body mass index, is a common problem in COPD patients, with its prevalence ranging from 17% to 47.2% and a pooled prevalence of 30.0%, and the pooled prevalence of being at risk of malnutrition in patients with COPD is 50.0%. […] Evidence suggests that malnutrition, as detected by the MNA score, is associated with several health-related outcomes, including morbidity and mortality. […] Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value. […] The poorer their nutritional status, the higher the risk. […] In particular, the MNA may also provide prognostic value; subjects at risk of malnutrition or with overt malnutrition in our analysis have a higher risk of moderate to severe acute exacerbations.
#29 The Impact of Malnutrition on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: The Predictive Value of the Mini Nutritional Assessment (MNA) versus Acute Exacerbations in Patients with Highly Complex COPD and Its Clinical and Prognostic Implications
https://www.mdpi.com/2072-6643/16/14/2303
Chronic obstructive pulmonary disease (COPD) is a major global health problem characterized by persistent airflow limitation and chronic systemic inflammation, with a significant impact on patientsâ overall health and well-being. […] Malnutrition, often suspected because of a low body mass index, is a common problem in COPD patients, with its prevalence ranging from 17% to 47.2% and a pooled prevalence of 30.0%, and the pooled prevalence of being at risk of malnutrition in patients with COPD is 50.0%. […] Evidence suggests that malnutrition, as detected by the MNA score, is associated with several health-related outcomes, including morbidity and mortality. […] Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value. […] The poorer their nutritional status, the higher the risk. […] In particular, the MNA may also provide prognostic value; subjects at risk of malnutrition or with overt malnutrition in our analysis have a higher risk of moderate to severe acute exacerbations.
#30 Prediction of long-term clinical outcomes using simple functional exercise performance tests in patients with COPD: a 5-year prospective cohort study | Respiratory Research | Full Text
https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-017-0598-6
The 1-min sit-to-stand (1-min STS) test and handgrip strength test have been proposed as simple tests of functional exercise performance in chronic obstructive pulmonary disease (COPD) patients. […] We found the 1-min STS test to be strongly associated with long-term mortality (hazard ratio per 3 more repetitions: 0.81, 95% CI 0.65 to 0.86) and moderately associated with long-term HRQoL. […] Our results suggest that the 1-min STS test may be useful for assessing the health status and long-term prognosis of COPD patients. […] The 1-min STS test was statistically significantly associated with 5-year mortality per 3 repetitions (hazard ratio (HR): 0.81, 95% CI 0.65 to 0.86), whereas the handgrip strength test was not statistically significantly associated with mortality. […] We found that over 5 years, the 1-min STS test was strongly associated with mortality and moderately associated with HRQoL. […] This supports and extends the existing evidence that the 1-min STS test could be useful for assessing health status and long-term prognosis in COPD patients.
#31 Prediction of long-term clinical outcomes using simple functional exercise performance tests in patients with COPD: a 5-year prospective cohort study | Respiratory Research | Full Text
https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-017-0598-6
The 1-min sit-to-stand (1-min STS) test and handgrip strength test have been proposed as simple tests of functional exercise performance in chronic obstructive pulmonary disease (COPD) patients. […] We found the 1-min STS test to be strongly associated with long-term mortality (hazard ratio per 3 more repetitions: 0.81, 95% CI 0.65 to 0.86) and moderately associated with long-term HRQoL. […] Our results suggest that the 1-min STS test may be useful for assessing the health status and long-term prognosis of COPD patients. […] The 1-min STS test was statistically significantly associated with 5-year mortality per 3 repetitions (hazard ratio (HR): 0.81, 95% CI 0.65 to 0.86), whereas the handgrip strength test was not statistically significantly associated with mortality. […] We found that over 5 years, the 1-min STS test was strongly associated with mortality and moderately associated with HRQoL. […] This supports and extends the existing evidence that the 1-min STS test could be useful for assessing health status and long-term prognosis in COPD patients.
#32 Deep learning for detecting and early predicting chronic obstructive pulmonary disease from spirogram time series | npj Systems Biology and Applications
https://www.nature.com/articles/s41540-025-00489-y
We propose DeepSpiro, a method based on deep learning for early prediction of future COPD risk. […] Our method can precisely forecast the probability of disease onset in undiagnosed high-risk patients over the next 15 years and beyond. […] Our work has made COPD detection and early risk prediction more accurate, ultimately contributing to improved clinical decision-making and patient prognosis. […] By providing interpretable results and predicting future risks, DeepSpiro has the potential to become a valuable early screening tool. […] This could help delay disease progression and may potentially reduce patient mortality. […] The model predicts individuals as a high-risk group for those identified as at risk of disease and as a low-risk group for those predicted not to have the disease.
#33 Deep learning for detecting and early predicting chronic obstructive pulmonary disease from spirogram time series | npj Systems Biology and Applications
https://www.nature.com/articles/s41540-025-00489-y
Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung condition characterized by airflow obstruction. […] In this study, we introduce a novel deep learning-based approach, DeepSpiro, aimed at the early prediction of future COPD risk. […] Evaluated on the UK Biobank dataset, DeepSpiro achieved an AUC of 0.8328 for COPD detection and demonstrated strong predictive performance for future COPD risk (p-value0.001). In summary, DeepSpiro can effectively predict the long-term progression of COPD disease. […] Therefore, timely and accurate COPD detection is crucial to reduce patient health risks. […] Failing to identify the disease during this crucial period will worsen its severity. […] Therefore, developing an artificial intelligence interpretable algorithm that can accurately detect patients with COPD and early predict an individual’s latent risk of COPD is crucial for slowing disease progression and preventing patient mortality.
#34 Deep learning for detecting and early predicting chronic obstructive pulmonary disease from spirogram time series | npj Systems Biology and Applications
https://www.nature.com/articles/s41540-025-00489-y
We propose DeepSpiro, a method based on deep learning for early prediction of future COPD risk. […] Our method can precisely forecast the probability of disease onset in undiagnosed high-risk patients over the next 15 years and beyond. […] Our work has made COPD detection and early risk prediction more accurate, ultimately contributing to improved clinical decision-making and patient prognosis. […] By providing interpretable results and predicting future risks, DeepSpiro has the potential to become a valuable early screening tool. […] This could help delay disease progression and may potentially reduce patient mortality. […] The model predicts individuals as a high-risk group for those identified as at risk of disease and as a low-risk group for those predicted not to have the disease.
#35 A machine learning framework for short-term prediction of chronic obstructive pulmonary disease exacerbations using personal air quality monitors and lifestyle data | Scientific Reports
https://www.nature.com/articles/s41598-024-85089-2
Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with a variety of symptoms including, persistent coughing and mucus production, shortness of breath, wheezing, and chest tightness. […] As the disease progresses, exacerbations, defined as acute worsening of respiratory conditions, may become more frequent, and life-threatening complications may develop. […] The results of our study set a premise for a predictive framework in COPD exacerbations, particularly investigating the potential influence of environmental features. […] The SHAP analysis revealed that the contribution of environmental features is not uniform across all subjects. […] The model interpretability analysis identified previous symptoms and cumulative pollutant exposure as key predictors of exacerbations.
#36 A machine learning framework for short-term prediction of chronic obstructive pulmonary disease exacerbations using personal air quality monitors and lifestyle data | Scientific Reports
https://www.nature.com/articles/s41598-024-85089-2
In particular, the best performing model resulted RF. […] These results suggest that for some COPD patients, characterised by higher COPD severity, the prediction of exacerbations is more difficult, as predictive models are more likely to provide false positives. […] The clustering analysis revealed the presence of two different patient sub-types, for which model performances are significantly different, being Cluster 2 the patient sub-type for which the prediction of exacerbations is more challenging. […] The SHAP summary plots were used to analyse the impact of each feature on model predictions in each cluster. […] In the most severe sub-type (cluster 2), NO2 was the main pollutant influencing exacerbation episodes, and previous exacerbations also had a notable impact on the exacerbation risk.
#37 A machine learning framework for short-term prediction of chronic obstructive pulmonary disease exacerbations using personal air quality monitors and lifestyle data | Scientific Reports
https://www.nature.com/articles/s41598-024-85089-2
The results obtained by the present study are somehow in line with the results obtained by other literature studies that used fixed air quality sensors to measure the exposure to air pollution, although a direct comparison cannot be done because datasets with different features and collected in different settings were used. […] The main goal of the framework is to predict exacerbations in the short term, providing clinicians with actionable information to intervene early. […] This early warning could prompt timely interventions, such as medication adjustments, environmental exposure reduction, or increased monitoring, potentially preventing exacerbations from occurring or mitigating their severity.
#38 Family
https://patents.google.com/patent/EP2823314A1/en
the method of the invention thus combines the determination of at least one specifically selected biomarker in a bodily fluid of a patient with the determination of at most three of the four BODE index parameters and correlates the biomarker level with the at most three determined BODE index values for the prognosis and/or risk assessment and/or monitoring of therapy and/or management of patients with COPD. […] the model including a biomarker was significantly better than the model using the BODE-index parameters alone, and the prediction of death within two years was similar or even better when a biomarker was combined with at most three of the BODE index parameters, especially the index parameters BOD or BD, omitting the index parameters E and/or O. […] the prognosis and/or risk assessment relates to the risk of mortality and patients are stratified into potential survivors and potential non-survivors.
#39 Family
https://patents.google.com/patent/EP2823314A1/en
the method of the invention thus combines the determination of at least one specifically selected biomarker in a bodily fluid of a patient with the determination of at most three of the four BODE index parameters and correlates the biomarker level with the at most three determined BODE index values for the prognosis and/or risk assessment and/or monitoring of therapy and/or management of patients with COPD. […] the model including a biomarker was significantly better than the model using the BODE-index parameters alone, and the prediction of death within two years was similar or even better when a biomarker was combined with at most three of the BODE index parameters, especially the index parameters BOD or BD, omitting the index parameters E and/or O. […] the prognosis and/or risk assessment relates to the risk of mortality and patients are stratified into potential survivors and potential non-survivors.
#40 COPD: Whatâs My Life Expectancy?
https://www.webmd.com/lung/copd/features/copd-life-expectancy
Theres no one-size-fits-all answer when it comes to predicting someones life span with COPD. A lot depends on your age, health, lifestyle, and how severe the disease was when you were diagnosed, plus the steps you’ve taken to lessen the damage afterward. […] In general, the higher your number on the GOLD system, the more likely you are to have problems with or even die from COPD. […] The higher your BODE score, the greater your risk for death from COPD. […] Rizzo says more studies are looking at COPD in terms of gender, age, and socioeconomic status. Someone with COPD who doesn’t have access to health care and doesn’t have insurance is more likely to have complications and die early, even if their diagnosis is the same as someone from a higher income level. […] An early diagnosis can also greatly improve your life expectancy. […] While there isn’t a drug to take care of COPD, there are many lifestyle changes you can make that will slow disease progression and improve your chances of living a longer life.
#41 COPD: Whatâs My Life Expectancy?
https://www.webmd.com/lung/copd/features/copd-life-expectancy
Theres no one-size-fits-all answer when it comes to predicting someones life span with COPD. A lot depends on your age, health, lifestyle, and how severe the disease was when you were diagnosed, plus the steps you’ve taken to lessen the damage afterward. […] In general, the higher your number on the GOLD system, the more likely you are to have problems with or even die from COPD. […] The higher your BODE score, the greater your risk for death from COPD. […] Rizzo says more studies are looking at COPD in terms of gender, age, and socioeconomic status. Someone with COPD who doesn’t have access to health care and doesn’t have insurance is more likely to have complications and die early, even if their diagnosis is the same as someone from a higher income level. […] An early diagnosis can also greatly improve your life expectancy. […] While there isn’t a drug to take care of COPD, there are many lifestyle changes you can make that will slow disease progression and improve your chances of living a longer life.
#42 Deep learning for detecting and early predicting chronic obstructive pulmonary disease from spirogram time series | npj Systems Biology and Applications
https://www.nature.com/articles/s41540-025-00489-y
Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung condition characterized by airflow obstruction. […] In this study, we introduce a novel deep learning-based approach, DeepSpiro, aimed at the early prediction of future COPD risk. […] Evaluated on the UK Biobank dataset, DeepSpiro achieved an AUC of 0.8328 for COPD detection and demonstrated strong predictive performance for future COPD risk (p-value0.001). In summary, DeepSpiro can effectively predict the long-term progression of COPD disease. […] Therefore, timely and accurate COPD detection is crucial to reduce patient health risks. […] Failing to identify the disease during this crucial period will worsen its severity. […] Therefore, developing an artificial intelligence interpretable algorithm that can accurately detect patients with COPD and early predict an individual’s latent risk of COPD is crucial for slowing disease progression and preventing patient mortality.
#43 Deep learning for detecting and early predicting chronic obstructive pulmonary disease from spirogram time series | npj Systems Biology and Applications
https://www.nature.com/articles/s41540-025-00489-y
Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung condition characterized by airflow obstruction. […] In this study, we introduce a novel deep learning-based approach, DeepSpiro, aimed at the early prediction of future COPD risk. […] Evaluated on the UK Biobank dataset, DeepSpiro achieved an AUC of 0.8328 for COPD detection and demonstrated strong predictive performance for future COPD risk (p-value0.001). In summary, DeepSpiro can effectively predict the long-term progression of COPD disease. […] Therefore, timely and accurate COPD detection is crucial to reduce patient health risks. […] Failing to identify the disease during this crucial period will worsen its severity. […] Therefore, developing an artificial intelligence interpretable algorithm that can accurately detect patients with COPD and early predict an individual’s latent risk of COPD is crucial for slowing disease progression and preventing patient mortality.
#44 COPD: Whatâs My Life Expectancy?
https://www.webmd.com/lung/copd/features/copd-life-expectancy
Theres no one-size-fits-all answer when it comes to predicting someones life span with COPD. A lot depends on your age, health, lifestyle, and how severe the disease was when you were diagnosed, plus the steps you’ve taken to lessen the damage afterward. […] In general, the higher your number on the GOLD system, the more likely you are to have problems with or even die from COPD. […] The higher your BODE score, the greater your risk for death from COPD. […] Rizzo says more studies are looking at COPD in terms of gender, age, and socioeconomic status. Someone with COPD who doesn’t have access to health care and doesn’t have insurance is more likely to have complications and die early, even if their diagnosis is the same as someone from a higher income level. […] An early diagnosis can also greatly improve your life expectancy. […] While there isn’t a drug to take care of COPD, there are many lifestyle changes you can make that will slow disease progression and improve your chances of living a longer life.
#45
https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide, causing 3.5 million deaths in 2021, approximately 5% of all global deaths. […] COPD is not curable but symptoms can improve if one avoids smoking and exposure to air pollution and gets vaccines to prevent infections. […] COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by a breathing test called spirometry, which measures how the lungs are working. […] COPD isn’t curable, but it can get better by not smoking, avoiding air pollution and getting vaccines. […] People living with COPD must be given information about their condition, treatment and self-care to help them to stay as active and healthy as possible.
#46 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonary Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd
Patients at high risk of imminent death are those with progressive unexplained weight loss or severe functional decline (eg, those who experience dyspnea with self-care, such as dressing, bathing, or eating). […] Mortality in COPD may result from comorbidities (eg, cardiovascular disease, cancer) or intercurrent illnesses rather than from progression of the underlying disorder in patients who have stopped smoking. Death is generally caused by acute respiratory failure, pneumonia, lung cancer, heart disease, or pulmonary embolism.
#47 Chronic Obstructive Pulmonary Disease (COPD) – Pulmonary Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd
Severity of airway obstruction predicts survival in patients with COPD. For an FEV1 35 to 55% predicted, the 5-year mortality is 40%. For an FEV1 less than 35% predicted, the 5-year mortality is 55%. […] More accurate prediction of risk of death is possible by simultaneously measuring body mass index (B), the degree of airflow obstruction (O, which is the FEV1), dyspnea (D, which is measured using the Modified British Medical Research Council (mMRC) Questionnaire), and exercise capacity (E, which is measured with a 6-minute walk test); this is the BODE index. Also, older age and the presence of heart disease, anemia, resting tachycardia, hypercapnia, or hypoxemia predict decreased survival, whereas a significant response to bronchodilators predicts improved survival. Risk factors for death in patients with acute exacerbation requiring hospitalization include older age, higher PaCO2, and use of maintenance oral corticosteroids.
#48 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal
https://pmc.ncbi.nlm.nih.gov/articles/PMC6776831/
Future prognostic research should steer towards recalibration or update of existing prognostic models with the addition of new predictors to enhance their prognostic performance. […] Prognostic tools with good calibration and external validity should inform clinical practice as well as be recommended by guidelines after they have undergone impact studies to examine the effect of using the model for a specific outcome in clinical practice.
#49 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal | The BMJ
https://www.bmj.com/content/367/bmj.l5358
Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimates that is, it informs clinicians how similar the predicted absolute risk is to the true (observed) risk in groups of patients classified in different risk strata. […] The most extensively validated prognostic models were the BODE index and the ADO index. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration. […] Future prognostic research should steer towards recalibration or update of existing prognostic models with the addition of new predictors to enhance their prognostic performance.
#50 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal
https://pmc.ncbi.nlm.nih.gov/articles/PMC6776831/
Future prognostic research should steer towards recalibration or update of existing prognostic models with the addition of new predictors to enhance their prognostic performance. […] Prognostic tools with good calibration and external validity should inform clinical practice as well as be recommended by guidelines after they have undergone impact studies to examine the effect of using the model for a specific outcome in clinical practice.
#51 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal
https://pmc.ncbi.nlm.nih.gov/articles/PMC6776831/
Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] Only a quarter of the models were internally validated, and a tenth of the models were externally validated. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimatesâthat is, it informs clinicians how similar the predicted absolute risk is to the true (observed) risk in groups of patients classified in different risk strata. […] The most extensively validated prognostic models were the BODE index and the ADO index. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration.
#52 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal | The BMJ
https://www.bmj.com/content/367/bmj.l5358
Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimates that is, it informs clinicians how similar the predicted absolute risk is to the true (observed) risk in groups of patients classified in different risk strata. […] The most extensively validated prognostic models were the BODE index and the ADO index. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration. […] Future prognostic research should steer towards recalibration or update of existing prognostic models with the addition of new predictors to enhance their prognostic performance.
#53
https://link.springer.com/article/10.1007/s11095-014-1490-4
Drug development in chronic obstructive pulmonary disease (COPD) has been characterised by unacceptably high failure rates. […] FEV1 is currently considered to be one of the best predictors of patient survival and as such has been used as a prognostic marker for outcome. […] Incorporation of the various interacting factors into a single model will offer the basis for patient enrichment and improved dose rationale in COPD. […] We have shown the performance of a joint model for trough FEV1 in a large COPD patient population, which takes into account disease progression, drug effects and dropout. […] Parameterisation of the disease processes was based on the assumption that spirometric measures result from a series of putative turnover processes, which can be modelled as a zero-order input rate and leading to FEV1 increase and a first-order elimination rate leading to FEV1 decrease.
#54
https://link.springer.com/article/10.1007/s11095-014-1490-4
The different covariates included in our final model were measured or recorded at the start of the studies (disease severity, gender, previous use of inhaled corticosteroids, body height). […] Using a joint model, we have shown that gender, height, disease severity at baseline, previous use of corticosteroids and dropout rates should be taken into consideration when designing early trials.