Bode Index as a Predictor of Severity in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Background And Objectives: Chronic Obstructive Pulmonary Disease as defined by the Global initiative for chronic obstructive lung disease is a common preventable and treatable disease, is characterized by persistant airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particles or gases. Exacerbation and comorbidities contribute to the overall severity in individual patients. As the global population ages, the burden of COPD increases in years to come. It continues to be an important cause of morbidity, mortality and health care costs worldwide. According to WHO, COPD was the 6th major cause of death in 1990 and is estimated to be the 3rd major cause by 2020. The present study has been undertaken to determine the factors other than the lung function that affect the outcome in COPD patients. The original BODE index is a simple multidimensional grading system which is superior to FEV1 alone for prediction of mortality and hospitalization rates among COPD patients. Method: In this study 100 male patients who attended the Department of Respiratory Medicine, with the symptoms suggestive of COPD were included in the study and the study was done to evaluate the BODE index as a predictor of hospitalization and severity in patients with COPD. Result: A total of 100 patients with symptoms suggestive of COPD as cases and were enrolled in the study. Among patients with COPD, there were 34 (34%) patients who had mild COPD with a BODE score between 0–2. Moderate (BODE score of 3–5) and severe COPD (BODE score more than or equal to 6) groups had 33 patients (33%) each. The average age of participants in the study was 56.13yrs.Among the COPD patients, BODE index was found to increase with age. The BODE score was significantly associated with the number of pack years of smoking. The average number of pack years of smoking is16.46, It was 7.42 pack yrs in mild cases, 15.07 in moderate and 26.90 in severe cases. The average BMI of the patients in this study was 21.48233 kg/m2. The BMI was found to be significantly lower in patients with COPD. It was 22.476 kg/m2 (standard deviation –2.455) in the mild group,21.711 kg/m2 (std. deviation – 2.552) in the moderate group and 20.260 kg/m2 (std. deviation – 3.212)in the severe group. A higher BODE score was associated with a higher incidence of hospital stay due to reasons related to COPD, over the past 2 years. The average duration of hospital stay over the last 2 years is 6.43 days. The mild COPD group did not have any significant hospital admission during the past 2 years, it was 0.13 days. The average duration of stay in the moderate study group was 3.17 days while, It was 16 days in the group with severe COPD according to the BODE score. Conclusion: BODE index is reliable method to predict hospitalization and the severity in patients with COPD. Since the assessment of BODE index requires only a spirometer, which is relatively inexpensive and can easily be made available, this index could be of great practical value in a primary health care setup to identify individuals who are at need for further evaluation in a higher center. Thus, the BODE index can be used for judicious referral of patients with COPD. There by preventing the wastage of the limited resources available.