Prognosis and management of chronic obstructive pulmonary disease in a real-world setting: A 5-year follow-up analysis of a multi-institutional registry

Abstract Background We conducted a prospective observational study to elucidate the long-term prognosis and management of chronic obstructive pulmonary disease (COPD) in Japan in the mid-2010s in clinical practice. Methods This prospective cohort study included 29 facilities. A total of 427 patients clinically diagnosed with COPD, enrolled between September 2013 and April 2016, were analysed. Interstitial pneumonia was excluded through a central multidisciplinary discussion. Follow-up data were collected for up to 5 years after patient registration. Results In total, 67 patients clinically diagnosed with COPD did not have airflow limitations (AFL) at the time of registration. In the cohort with AFL (n=370), 266 patients completed a 5-year follow-up, while 58 patients died during the 1556.7 person-years of observation. The overall 5-year survival rate was 85.2%. Stratified by % forced expiratory volume in one second (FEV1), survival rates were 93.4% in the 50 ≤ %FEV1 group, 82.5% in the 30 ≤ %FEV1 < 50 group, and 66.1% in the %FEV1 < 30 group. The prognosis of the subpopulation without AFL was poor with 5-year survival of 83.0%. This subpopulation exhibited respiratory symptoms, low vital capacity and total lung capacity, and emphysematous changes. Conclusions Our study presents the 5-year survival and real-world clinical practice scenario of a prospective cohort of patients clinically diagnosed with COPD in Japan in the mid-2010s. Overall, 13% of the patients in this cohort did not show AFL at registration with respiratory symptoms, distinct spirometric patterns, and poor prognosis.