The Dyspnoea, Obstruction, Smoking, Exacerbation (DOSE) index is predictive of mortality in COPD

Sundh, Josefin; Janson, Christer; Lisspers, Karin; Ställberg, Björn; Montgomery, Scott

doi:10.4104/pcrj.2012.00054

Cited by 92 publications

(72 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[26][27][28][29][30] Others involved retrospective analyses of existing databases, were focused on inpatients or mortality, and were not directly applicable to the emergency department. [31][32][33][34][35] Strengths and limitations Our study had several strengths, including multi centre and rigorous prospective collection of real-time clinical data, comprehensive followup and unique use of the 3-minute walk test. Nonetheless, some aspects of the study warrant discussion.…”

Section: E200mentioning

confidence: 99%

Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study

Stiell

Clement

Aaron

et al. 2014

CMAJ

View full text Add to dashboard Cite

Section: E200mentioning

confidence: 99%

Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study

Stiell

Clement

Aaron

et al. 2014

CMAJ

View full text Add to dashboard Cite

“…2 This is an important paper, since it adds knowledge to the existing applicability of DOSE which previously has been shown to predict hospitalisation, respiratory failure and exacerbation risk. 3 The authors investigated 1,111 COPD patients aged 34-75 years, randomly selected from 70 Swedish primary and secondary care centres.…”

Section: Editorialsmentioning

confidence: 99%

Using COPD multidimensional indices in routine clinical practice: DOSE meets all criteria

Chavannes

Jones

Postma

et al. 2012

Primary Care Respiratory Journal

View full text Add to dashboard Cite

EditorialsHow should we employ multidimensional indices of COPD? Ideally, they should serve to work towards 'optimal COPD care', based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risk.1 However, this integration has (until recently) been overlooked, largely because multidimensional indices have usually been developed in selected patient groups and thus lack external validity in the community.In this issue of the PCRJ, Josefin Sundh and colleagues present a large study assessing the merits of the DOSE (dyspnea, obstruction, smoking, exacerbations) index in predicting mortality in both primary and secondary care patients.2 This is an important paper, since it adds knowledge to the existing applicability of DOSE which previously has been shown to predict hospitalisation, respiratory failure and exacerbation risk. 3 The authors investigated 1,111 COPD patients aged 34-75 years, randomly selected from 70 Swedish primary and secondary care centres. 562 patients had complete data on all DOSE index components, i.e. MRC dyspnoea scale, forced expiratory volume in 1 second (FEV1) expressed as percent predicted (FEV1 %pred), smoking status, and exacerbation rate. Over the course of five years, 116 patients (20.6%) died. Mortality was higher in patients with a DOSE index score >4 (42.4%) than for lower scores (11.0%) (p<0.0001). Compared with a DOSE index score of 0-3, the hazard ratio for mortality was 3.48 (95% CI 2.32 to 5.22) for a score of 4-5, and 8.00 (95% CI 4.67 to 13.7) for a score of 6-8. Thus, the DOSE index has now been shown to be associated with mortality in COPD patients in both primary and secondary care, and can be used to assess prognosis in addition to other clinically relevant issues.Originally, DOSE was designed as a predictor of health status, whereas both BODE (BMI, Obstruction, Dyspnoea, Exercise) and ADO (Age, Dyspnoea, Obstruction) were derived as predictors of mortality. ADO has the disadvantage that it is affected by age; younger people with worse COPD based on MRC or FEV1 score better than their older counterparts. This is counterintuitive, since one would expect younger people with advanced COPD to have more serious disease than older people.4 BODE has been studied extensively, yet has the major practical drawback that it requires a 6-minute walking test. This stems from its original development in a rehabilitation setting. However, the majority of COPD patients are managed in primary care where this test is not usually performed -although it could be, provided trained personnel and a 30m hallway were available.To use any given index in primary care it should be able to identify individuals with the highest current burden of disease who are at risk of future morbidity and mortality. General criteria for the use of an index in routine clinical practice are that it should be: (i) simple to record and calculate, (ii) the component items should be easy to assess and record, (iii) the component items should be clinically imp...

show abstract

“…9 The mMRC questionnaire relates well to other measures of health status and predicts future mortality risk. 10 Cough is often the first symptom of COPD. Cough may be productive or unproductive.…”

Section: Introductionmentioning

confidence: 99%

A study of the clinical profile of 50 patients of COPD with correlation between clinical, radiological and spirometric evaluation

Kamdar

Patel

2017

Int J Res Med Sci

View full text Add to dashboard Cite

Background: Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation that is due to airway and/ or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. Tobacco smoking, occupational exposure to organic and inorganic dusts, chemical agents and fumes and biomass cooking are the risk factors for COPD. Chronic dyspnoea, cough, sputum production, wheezing and chest tightness are the common symptoms of COPD. The present study was undertaken to evaluate the clinical, radiological and spirometric parameters in patients with COPD and to demonstrate a correlation between them. Methods: This was a prospective study of 50 patients of COPD who presented to out-patient department. We included all patients above 40 years of age with a smoking index of 200 or more, or history of exposure to occupational dust, biomass fuel gas or exposure to other obnoxious gases; and who had history of dyspnoea and cough. Spirometry was performed to confirm the diagnosis and to grade the severity of airflow obstruction. History of dyspnoea, cough, sputum production, wheezing, chest tightness, fever, weight loss and the number of exacerbations in the previous year was noted. We then performed a detailed clinical examination. Blood was sent for haemogram and arterial blood gas analysis and all patients underwent an ECG, 2-D Echo and HRCT of the thorax. We then studied the correlation between the clinical, radiological and spirometric profiles in these patients. Results: Out of the 50 patients, majority was between 50-59 years of age, with male to female ratio of 1.94:1.00. History of smoking was present in 74% patients, exposure to biomass fuel in 12% and exposure to occupational dust in 6% patients. Commonest symptom was dyspnoea (in 100% patients) followed by cough (88%), sputum production (68%), wheezing (58%), chest tightness and fever (30%) and weight loss (28%). HRCT was positive in 75% patients, while ECG changes were seen in 42% patients and pulmonary hypertension was present in 54% patients. A significant association was observed between grade 5 dyspnoea on mMRC, hypoxia, hypercarbia, pulmonary hypertension and Gold-5 airflow obstruction. Conclusions: In the present study of 50 cases, COPD was seen predominantly in male patients, with a mean age of presentation between 50-59 years. Tobacco smoking was the commonest etiological factor. Clinical symptoms most commonly documented were dyspnoea, cough with or without expectoration, wheezing, chest tightness, fever and weight loss. A significant association was observed between grade 5 dyspnoea on mMRC, hypoxia, hypercarbia, pulmonary hypertension and Gold-5 airflow obstruction.

show abstract

The Dyspnoea, Obstruction, Smoking, Exacerbation (DOSE) index is predictive of mortality in COPD

Cited by 92 publications

References 35 publications

Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study

Clinical characteristics associated with adverse events in patients with exacerbation of chronic obstructive pulmonary disease: a prospective cohort study

Using COPD multidimensional indices in routine clinical practice: DOSE meets all criteria

A study of the clinical profile of 50 patients of COPD with correlation between clinical, radiological and spirometric evaluation

Contact Info

Product

Resources

About