COPD is a chronic, progressive disease showing great variation in its natural history. Spirometry providing data on FEV 1 and FVC is the most common measure of disease progression. A large cohort of patients with COPD of GOLD stage II+ followed up every 6 months for 3 years showed a mean annual decline in FEV 1 of 33 mL. An annual decline in FEV 1 >40 mL was seen in 38% of the patients, while 8% showed an average annual increase of 20 mL. Current smoking and emphysema are related to more rapid decline in FEV 1 .

In addition to rapid decline in FEV 1 , factors that indicate a poor prognosis in established COPD are frequent exacerbations, respiratory insufficiency, nutritional status and comorbidities.

Smoking cessation is the most important intervention that affects the prognosis of the disease.

See the entire Obstructive pulmonary disease Chapter