Prognosis and duration of disabling effects
Chronic Obstructive Pulmonary Disease and Emphysema are chronic progressive disorders characterised by airflow limitation. They are essentially progressive conditions, which worsen with time, especially if the person continues to smoke.
Pulmonary rehabilitation (to achieve optimum fitness) can reduce symptoms and improve function. Controlled oxygen therapy for more than 15 hours a day has been shown to increase survival significantly.
Smoking cessation is the single most effective intervention to reduce the risk of further development. Cessation of smoking may slow the decline in lung function to normal levels of decline in a relatively short time. This would not affect the prognosis of moderate and severe disease because the damage is done, but may improve the prognosis in mild disease.
The prognosis in moderate and severe COPD therefore, is likely to be life-long with consequent care and mobility needs, which will not improve as the disease is progressive and the person is likely to gradually deteriorate.
COPD (chronic bronchitis and emphysema)
At first the only symptom for many years may be a “smoker’s cough”.
This symptom progresses to cough with sputum, wheeze and breathlessness. Chest infections occur more and more regularly with colds causing the production of sputum. These infections increase in severity and duration until a cough is constantly present.
With progression of the disease, the person experiences increasing breathlessness on exertion.
With advanced disease, breathlessness becomes severe and occurs at rest and normally affects all aspects of daily life. At end-stage disease, the person is bed-bound or chair-bound and likely to be on oxygen for several hours a day. It is a chronic, slowly progressive disorder with little variation over a period of time.
Bronchodilator therapy may help the degree of airflow obstruction to some extent as most patients have some degree of asthmatic-type responsiveness to bronchodilators. 20-30% of patients improve somewhat when given a course of steroids and inhaled corticosteroids may be indicated. Long- term oral corticosteroid treatment should normally be avoided.
The disease is regarded as being progressive, with a continuous steady decline in lung function.
In all cases - Indefinite award
Emphysema
The best predictor of survival is the FEV1 after bronchodilator use.
Emphysema gradually develops over a number of years.
People with emphysema have great difficulty in exhaling (breathing out). Symptoms such as shortness of breath (sometimes associated with wheeze) occur initially on exertion and then as the disease progresses with little exertion and ultimately at rest. The person eventually may not be able to carry out basic activities in a normal fashion.
With advanced disease, breathlessness becomes severe and occurs at rest and normally affects all aspects of daily life.
At end-stage disease, the person is bed-bound or chair-bound and likely to be on oxygen for several hours a day.
It is a chronic, slowly progressive disorder with little variation over a period of time.
Bronchodilator therapy may help those who have a tendency to airways constriction.
Some patients improve somewhat when given a course of steroids and inhaled corticosteroids may be indicated. Long-term oral corticosteroid treatment should be avoided.
No medication has been shown to restore lost lung function.
In all cases - Indefinite award
All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.
