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The following may occur as COPD worsens:
- Intervals between acute periods of worsening of dyspnea (exacerbations) become shorter.
- Cyanosis (discoloration of the skin) and failure of the right side of the heart may occur.
- Anorexia and weight loss often develop and suggest a worse prognosis.
Cigarette smoking or exposure to tobacco smoke is the primary cause of COPD. While COPD occurs in 15% of cigarette smokers, tobacco use accounts for as much as 90% of the risk for the development of this disease.
Secondhand smoke or environmental tobacco smoke also increase the risk of respiratory infections and can result in a decrease in lung function.
People with COPD experience a more rapid decline in what is called forced expiratory volume, or FEV. FEV is the maximum volume of air that can be exhaled within a specified time period, starting from maximal inhalation. A subscript indicates the time period in seconds. For example, FEV1 is the maximum volume of air that can be exhaled within 1 second. A decline in FEV causes a person to become short of breath and to have difficulty breathing. It is important to note, that an individual that has a more rapid decline in lung function from tobacco abuse, returns to a normal, slower decline when they quit smoking cigarettes.
For people with mild COPD, the prognosis is favorable. More severe cases of COPD suggest a worse prognosis. Of those people who are admitted to the ICU with an acute exacerbation, the death rate is 24%. This rate doubles for people aged 65 years or older. The predictors of death due to COPD are as follows:
- Continued smoking
- Accelerated decline in FEV1
- Moderate-to-severe airflow obstruction
- Poor bronchodilator response
- Severe hypoxemia
- Presence of hypercapnia (increased arterial carbon dioxide tension)
- Development of cor pulmonale (right-sided heart failure)
- Overall poor functional capacity
For more information, read our full medical article on COPD.
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