COPD: The prognosis also depends on FEV1

But what does a diagnosis of chronic obstructive pulmonary disease (COPD) actually mean for life expectancy? An American study published in JAMA Internal Medicine provides some context. In a cohort of nearly 46,000 adults, with a median follow-up of 15.2 years, COPD was associated on average with a loss ranging from 0.7 years in cases of mild obstruction (GOLD stage 1) to 7.1 years in cases of very severe obstruction (GOLD stage 4), with the gap widening significantly from the moderate stage onward.Until now, available estimates of life expectancy with COPD have remained limited and often based on older or unrepresentative cohorts. The prognosis for non-smokers was even less well documented. A team including researchers from the University of Alabama at Birmingham and Columbia University in New York sought to measure life expectancy and years lost in the general population according to the severity of airway obstruction.The researchers harmonized data from eight American population cohorts, comprising 45,886 adults with an average age of 52.4 years, 56.3% of whom were women. Nearly half had never smoked. In total, 8,058 participants presented with airway obstruction defined by a forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of less than 0.70 before bronchodilator administration.Severity was then classified according to predicted FEV1, from mild obstruction at GOLD stage 1 (FEV1 ≥ 80%) to very severe at GOLD stage 4 (FEV1 < 30%). The majority of affected participants were in stages 1 or 2; only 561 were classified as GOLD 3 and 106 as GOLD 4. A Gompertz model was used to estimate survival and life expectancy. The calculation of years lost took into account factors such as age, sex, education, body mass index, smoking status, and several comorbidities. However, this definition was based on prebronchodilator spirometry, whereas in practice the diagnosis must be confirmed after bronchodilator administration.The results show a clear gradient according to the severity of the obstruction:From 0.7 to 7.1 years of life lost: After adjustment, the average loss was 0.71 years at GOLD stage 1 (95% confidence interval [CI]: 0.34–1.08), 2.58 years at GOLD stage 2 (2.21–2.95), 5.07 years at GOLD stage 3 (4.39–5.74), and 7.12 years at GOLD stage 4 (5.21–9.04). Across all stages, COPD was associated with 1.94 years of life lost (1.66–2.22).At age 65, the difference becomes very real: Remaining life expectancy was estimated at 21.5 years without COPD, compared to 20.0 years at GOLD stage 1, 16.4 years at GOLD stage 2, 13.1 years at GOLD stage 3, and 10.7 years at GOLD stage 4. These age-adjusted differences do not directly correspond to the years of life lost in the primary outcome, which is calculated after taking into account a broader range of factors.Beyond smoking: The analysis reveals that the impact of COPD on life expectancy is comparable in non-smokers (2.02 years of life lost) and in smokers or former smokers (between 1.90 and 1.93 years). While smoking remains a major aggravating risk factor, the disease weighs heavily on survival regardless of smoking status.An order of magnitude comparable to several major risk factors: As benchmarks, researchers estimated the loss associated with hypertension at 2.7 years, that related to diabetes at 4.1 years, that related to obesity at 0.5 years, and that related to smoking at 5.5 years. From GOLD stage 2 onward, COPD was therefore of a comparable or greater order of magnitude than several of these factors.A discussion tool, not a countdownBeyond the increased risk of mortality, the study's value lies in how it translates this risk into years of life. The authors emphasize that "even mild obstruction is associated with a substantial reduction in life expectancy." This finding becomes particularly pronounced from GOLD stage 2 onward and also applies to people who have never smoked, thus broadening the perception of a disease still often reduced to smoking.In the editorial accompanying the study, Drs. Teva D. Brender and Deborah Grady stress that these estimates can help patients and their clinicians assess the impact of the disease, guide decisions, and plan care. They could be "particularly important for discussions with patients and clinical decision-making in younger patients."What the numbers cannot predictThese population averages can inform a prognostic discussion, but they do not predict the outcome for any given patient. COPD was defined based on a single prebronchodilator spirometry test, without considering subsequent changes in obstruction or smoking status. Life expectancy was extrapolated using modeling. Furthermore, the most advanced stages were underrepresented: 561 participants were in GOLD stage 3 and only 106 in GOLD stage 4, increasing the uncertainty surrounding the most severe estimates.In Quebec, approximately 10% of people aged 35 and over have been diagnosed with COPD, a proportion that rises to nearly one in four after age 75. However, the disease often remains underdiagnosed. The results of this study therefore reinforce the importance of earlier detection, before obstruction becomes moderate or severe.References:Bhatt SP, Sun Y, Wang Y, Balte PP, et al. Life Expectancy in Chronic Obstructive Pulmonary Disease. JAMA Intern Med. July 1, 2026;186(7):852-860. doi: 10.1001/jamainternmed.2026.0207Brender TD, Grady D. Quantifying Life Expectancy and Years of Life Lost in a Large Contemporary Cohort of Individuals With COPD. JAMA Intern Med. 2026;186(7):801. doi: 10.1001/jamainternmed.2026.0213This article has been translated from its original French and first appeared on our sister site Profession Santé.

COPD: The prognosis also depends on FEV1

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