Chest
Volume 126, Issue 5, November 2004, Pages 1443-1451
Journal home page for Chest

Clinical Investigations
COPD
Predictors of Survival in Severe, Early Onset COPD

https://doi.org/10.1378/chest.126.5.1443Get rights and content

Study objectives:

Multiple risk factors for mortality in patients with COPD have been described, but most studies have involved older, primarily male subjects. The purpose of this study was to determine the mortality rate and predictors of survival in subjects with severe, early onset COPD.

Design, setting, and participants:

The cohort of 139 probands in the Boston Early-Onset COPD Study was recruited from lung transplant and general pulmonary clinics between September 1994 and July 2002. Subjects were < 53 years old, had an FEV1 of < 40% of predicted, did not have severe α1-antitrypsin deficiency, and had not undergone lung transplantation. The initial evaluation included a standardized respiratory questionnaire, spirometry, and a blood sample. A follow-up telephone interview was conducted between May and December 2002.

Measurements and results:

Subjects were young (mean age at enrollment, 47.9 years) and had severe airflow obstruction (mean baseline FEV1, 19.4% predicted). A total of 72.7% of the subjects were women (p < 0.0001 [comparison to equal gender distribution]). The median estimated survival time was 7.0 years from the time of study enrollment, determined by the Kaplan-Meier method. The majority of deaths were due to cardiorespiratory illness. In a multivariable Cox proportional hazards model, adjusting for age, gender, and baseline FEV1, lifetime cigarette consumption (hazard ratio [HR], 1.20 [per 10 pack-years]; 95% confidence interval [CI], 1.02 to 1.40) and recent smoking status (HR, 2.50; 95% CI, 1.03 to 6.05) were both significant predictors of mortality.

Conclusion:

In this cohort, recent smoking status predicted increased mortality independent of the effects of lifetime smoking intensity. Smoking cessation may confer a survival benefit even among patients with very severe COPD.

Section snippets

Study Participants

The recruitment of participants with severe, early onset COPD was performed in three phases. Details of the 44 probands in phase 1 (September 1994 to October 1996) and the 40 probands in phase 2 (January 1998 to June 1999) have been reported previously.16,18 Fifty-five additional probands were recruited in phase 3 (June 1999 to July 2002). In all three phases, participants with severe, early onset COPD were enrolled primarily from the lung transplant and LVRS programs at Brigham and Women’s

Baseline Characteristics of Early Onset COPD Subjects

A total of 139 probands were enrolled in the three phases of the study (Table 1). Details of the demographics and spirometry of the first 84 probands (phases 1 and 2) have been previously reported.16,18 The female predominance noted through the first two phases (71.4% women) persisted in the third phase (74.6% women), and both of these values are significantly different than the predicted equal sex distribution (p < 0.0001 [phases 1 and 2]; p = 0.0003 [phase 3]). Overall, women make up 72.7% of

Discussion

Since the 1960s, multiple studies have investigated the risk factors that influence mortality in a variety of populations of COPD patients. In the current report, we examined the survival of a unique cohort of subjects with severe early onset COPD. The most striking finding was that two separate measures of cigarette smoking had the strongest effect on outcome. The number of pack-years smoked prior to study enrollment as well as smoking during the follow-up period were both independent

ACKNOWLEDGMENT

We thank Ms. Kimberly Ladouceur for her tremendous assistance with recruitment and follow-up of the study subjects, and Drs. Harold Chapman, Frank Speizer, and Scott Weiss for their support and participation throughout all phases of the Boston Early-Onset COPD Study and for their helpful advice regarding this manuscript. We appreciate the assistance of many physicians in recruiting study participants. We are especially thankful for the enthusiastic support from the members of the early onset

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