BODE Index: A Predictor of COPD Exacerbation

Abstract

Introduction: The severity of COPD (chronic obstructive pulmonary disease) is often graded using parameter like Forced Expiratory Volume (FEV1). The BODE (body mass index, degree of airflow obstruction, dyspnea grading and exercise testing) index is a multi-dimensional tool taking into account body mass index, severity of obstruction, dyspnea grading and 6MWT (six minute walk test) to assess severity of COPD. Objective: To study BODE index as a predictor of risk of exacerbation for improving COPD outcome. Materials and Methods: We conducted a prospective study over a period of 2 years, on 60 stable COPD patients by evaluating the body-mass index, spirometry, Modified Medical Research Council (mMRC) dyspnea scale and 6MWT and categorizing into mild, moderate and severe COPD cases on the basis of spirometry and into 4 quartiles on the basis of BODE index value (scores 0-2, 3-4, 5-6 and 7-10). We investigated the prognostic value of BODE quartiles for both the number and severity of exacerbations requiring ambulatory treatment, emergency room visit or hospitalization. Results: In our study, spirometry showed mild obstruction in 16.7%, moderate obstruction in 26.7%, severe obstruction in 38.3% and very severe obstruction in 18.3% of patients. According to BODE score 52% of patients were quartile 1, 21% quartile 2, 15% quartile 3 and 12% were quartile 4. There was a significant relation between BODE index and COPD severity (p < 0.001). In our study, 8.3% patients had no exacerbation; maximum number of exacerbation were 7 observed in 8.3 % patients and 21.7% of patients had 3 exacerbations in 2 years and 16.7% patients had 1 exacerbation in 2 years. It was observed that higher the BODE index; greater is the severity of COPD and more are the number of exacerbations. Conclusion: BODE index should be calculated in every COPD patients for better prediction of risk of exacerbation, hospitalization and for judicious referral of patients with COPD, thereby preventing the wastage of the limited resources available.