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Background and Objectives:  We studied whether the extent of exertional oxygen desaturation and emphysema could cause greater mortality in COPD and asthma independent of airflow obstruction.  Materials and Methods:  We performed a 5-year longitudinal observational study in COPD and asthma patients who matched for airflow obstruction severity. All subjects performed a 6-min walk test (6MWT) and high-resolution computed tomography (HRCT) and followed spirometry and oxygen saturation (SpO 2 ) during the 6MWT every 3–6 months. Overall survival was recorded. Cumulative survival curves were performed according to the Kaplan–Meier method and compared with the log-rank test.  Results:  The COPD group had higher emphysema scores, higher Δinspiratory capacities (ICs) and lower SpO 2  during the 6MWT, which showed a greater yearly decline in FEV 1  (40.6 mL) and forced vital capacity (FVC) (28 mL) than the asthma group (FEV 1 , 9.6 mL; FVC, 1.2 mL;  p  < 0.05). The emphysema-predominant COPD group had an accelerated annual decline in lung function and worse survival. The nadir SpO 2  ≤ 80% and a higher emphysema score were the strong risk factors for mortality in COPD patients.  Conclusions:  The greater structural changes with a higher emphysema score and greater desaturation during the 6MWT in COPD may contribute to worse yearly decline in FEV 1  and higher five-year mortality than in asthma patients with a similar airflow obstruction. The lowest SpO 2  ≤ 80% during the 6MWT and emphysema-predominant COPD were the strong independent factors for mortality in chronic obstructive airway disease patients.

medicina

Emphysema-Predominant COPD Had a Greater 5-Year Mortality and a Worse Annual Decline in Lung Function Than Airway Obstruction-Predominant COPD or Asthma at Initial Same Degree of Airflow Obstruction