Predicting Life Expectancy in People With COPD

Man wearing an oxygen mask in the hospital
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The life expectancy of a person with chronic obstructive pulmonary disease (COPD) is a topic that most people would rather not talk about. But if you or a loved one have been diagnosed with the disease, then you've probably spent a great deal of time thinking about it.

Understanding the possible outcome (prognosis) of a disease can often motivate people to make much-needed changes that may improve their quality of life and help them live longer.

In the end, the average life expectancy of persons with COPD is just that—an average. You can often exceed expectations by taking charge and addressing the factors that you can change.

How to Predict Life Expectancy

While there are no hard-and-fast rules that govern how long a person can live with COPD, a system called the BODE Index has been developed as a means to predict survival times. Using points based on 4 different measures of lung function, the BODE score makes a prediction about how long someone will live after a diagnosis of COPD.

The 4 Factors in the BODE Index

Four different factors are evaluated as part of the BODE index. Each of these factors can make some prediction about the prognosis of COPD, but added together the prediction is more accurate. The letters stand for:

  • B - BMI - BMI stands for body mass index, a calculation made by comparing height vs weight.
  • O - Airway obstruction - Airway obstruction is measured by evaluating FEV1 — the amount of air that can be forcefully exhaled in 1 second after a deep breath.
  • D - Dyspnea - Dyspnea refers to the degree of breathlessness someone experiences while living with COPD.
  • E - Exercise tolerance - Exercise testing refers to how well some do on a six-minute walk test.

Breaking Down the BODE Index

To understand how these factors contribute to mortality in people with COPD, we'll look at each within the context of disease progression.

B - Body Mass Index

BMI is a calculation that is made by comparing height in meters by weight in kilograms. There are calculators for determining BMI, as well as tables BMI is an estimate of how overweight or underweight a person is. With COPD, being underweight or malnourished is a poor sign when it comes to prognosis.

Body Mass Index Values

  • 0 points for a BMI greater than 21
  • 1 point for a BMI less than 21

O - Airway Obstruction

Measured by a simple test known as spirometry, airway obstruction looks at two markers: forced expiratory volume (FEV1) and forced vital capacity (FVC). FEV1 is a measure of the amount of air which can be forcefully exhaled in one second. FVC is the amount of air that can be exhaled altogether after a deep breath. The ratio of FEV1/FVC, therefore, represents what percentage of the total air that can be exhaled in one second versus all the air that can be exhaled. Normally this ratio is around 1, which means that we exhale the majority of air in the first second of exhalation. If there is an obstruction in the airways that slows or prevents this rapid exhalation of air, the ratio decreases.

Airway Obstruction Values

  • 0 points for an FEV1 greater than 64%
  • 1 point for an FEV1 of 50-64%
  • 2 points for an FEV1 of 36-49%
  • 3 points for an FEV1 of less than 36%

FEV1 is a strong predictor of survival in people with COPD. Those with severe airway obstruction on long-term oxygen therapy have low survival rates (roughly 70 percent to year one, 50 percent to year two, and 43 percent to year three).

D - Dyspnea

Dyspnea is the term that refers to the physical sensation of shortness of breath or breathlessness. Doctors may distinctions based on what someone may need to do—how active they are—before they become short of breath. Early on, a person with COPD may only become breathless if they walk five miles. Later on, that same person may note breathlessness with any movement at all. The symptom of dyspnea is objectified by a measurement called the modified Medical Research Council (MMRC) Dyspnea Index. In this measurement, breathlessness is measured on a scale of 0 to 4:

  • MMRC 0: Breathless with only strenuous exercise
  • MMRC 1: Short of breath when hurrying on level ground or walking up a slight hill
  • MMRC 2: Short of breath on level ground and needing to stop intermittently to rest due to breathlessness (and walks slower than other people of own age)
  • MMRC 3: Short of breath and having to stop after walking about 100 meters or after a few minutes (even though walking at own pace)
  • MMRC 4: Too breathless to leave house or breathless when dressing

Dyspnea Values

  • 0 points for a dyspnea index of 0-1
  • 1 point for a dyspnea index of 2
  • 2 points for a dyspnea index of 3
  • 3 points for a dyspnea index of 4

Dyspnea evaluation rates a person's perception of their COPD symptoms and translates those perceptions into measurable value. While FEV1 has been regarded as the best way to predict COPD mortality, the dyspnea level may be more significant when predicting survival.

E - Exercise Tolerance

Exercise capacity may be dramatically reduced by COPD. Exercise tolerance refers to how active someone is able to be with the restrictions put forth by their lung disease. A standard test called the six-minute walk test is used to obtain the value for the BODE index. It can provide both an estimate of mortality and a baseline by which people can effect positive lifestyle changes.

Exercise Tolerance Values

  • 0 point if able to walk over 349 meters
  • 1 point if able to walk 250-249 meters
  • 2 points if able to walk 150-249 meters
  • 3 points if able to walk 150 meters or less

It is now known that age may also play a role in the BODE index's accuracy.

Values and Ranges

The BODE Index is graded on a scale of 0 to 10, with lower grades corresponding to longer survival times and higher grades corresponding to shorter survival times.

With each of the individual values, your clinician can predict what your outcome will be and offer ways to improve upon your BODE grading. As a prognostic tool, the BODE index can estimate the likelihood of you surviving for four years based on the following percentages:

  • 0 to 2 points: 80 percent
  • 3 to 4 points: 67 percent
  • 5 to 6 points: 57 percent
  • 7 to 10 points: 18 percent

Predicting Mortality

The BODE index provides only a general prediction of mortality. Please note that there are many other factors that can affect mortality in people with COPD, and this test is not perfect. Someone with a very high score could end up living for decades and someone with a low score could pass tomorrow. Tests like this are good for making general predictions and evaluating statistics, but they do not necessarily give predictive information for individual people.

The BODE Index is meant to be used as a tool for informational purposes only. It should not replace the advice of a healthcare professional.

COPD and Lung Cancer Risk

Another major factor contributing to the life expectancy of someone with COPD is lung cancer risk. COPD is considered an independent risk factor for lung cancer, meaning that just having COPD greatly increases your chances of contracting cancer, regardless of whether you ever smoked cigarettes.

Nonsmokers with COPD are more likely to develop lung cancer than nonsmokers without COPD, and smokers with COPD are more likely to develop lung cancer than those who smoke and don't have COPD.

If you have COPD, talk to your physician about a lung cancer screening, and familiarize yourself with the symptoms of the condition.

A Word From Verywell

Predicting life expectancy with COPD is not an exact science. Talk to your doctor about a lung cancer screening, and remember that the important thing about the BODE index is not that it dictates how long you have to live but what steps you can take to embrace a healthy lifestyle. Chief among these is smoking. No other changeable factor has a greater impact on your survival time than the habit of lighting up.

If you are a smoker with COPD, there are three goals you need to embrace:

  • Quitting smoking is the single most effective (and least expensive) way to either prevent COPD or slow progression of the disease. Lung function decline can stop and even normalize once you quit, irrespective of your age, weight, or gender.
  • Avoiding secondhand smoke means taking steps to not only address your smoking but those around you. There's no point in sitting back politely if the air you breathe contains the same carcinogenic fumes.
  • Joining a smoking support group further increases your odds of quitting and remaining cigarette-free. Going in alone, even with cessation drugs, can be difficult as it fails to address the emotional components of addiction.

These changes, along with an appropriate, doctor-led exercise program, offer the best means to ensure an improved quality of life if you have COPD.

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Article Sources

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  1. Powrie DJ. The BODE index: a new grading system in COPDThorax. 2004;59(5):427-427. doi:10.1136/thx.2004.la0089.

  2. King DA, Cordova F, Scharf SM. Nutritional aspects of chronic obstructive pulmonary diseaseProc Am Thorac Soc. 2008;5(4):519–523. doi:10.1513/pats.200707-092ET

  3. Bailey KL. The importance of the assessment of pulmonary function in COPDMed Clin North Am. 2012;96(4):745–752. doi:10.1016/j.mcna.2012.04.011

  4. Rajala K, Lehto JT, Sutinen E, Kautiainen H, Myllärniemi M, Saarto T. mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosisERJ Open Res. 2017;3(4):00084-2017. doi:10.1183/23120541.00084-2017

  5. Regueiro EM, Di Lorenzo VA, Basso RP, Pessoa BV, Jamami M, Costa D. Relationship of BODE Index to functional tests in chronic obstructive pulmonary diseaseClinics (Sao Paulo). 2009;64(10):983–988. doi:10.1590/S1807-59322009001000008

  6. MDCalc. BODE Index for COPD Survival.

  7. Durham AL, Adcock IM. The relationship between COPD and lung cancerLung Cancer. 2015;90(2):121–127. doi:10.1016/j.lungcan.2015.08.017