PURPOSE: The authors hypothesized that a multidimensional grading system as FEV1- body mass index correlation within BODE score index system could better assessed the respiratory and systemic expressions of COPD and, also, permit to categorize and predict outcome in active workers patients.
METHODS: Between January 2008 and October 2010, a total of 105 inpatients with a wide range in severity of Chronic Obstructive Pulmonary Disease (COPD) were recruited from departments of Constantza Clinical Pneumology Hospital. COPD was defined by a history of al least 10 pack-years and a ratio of FEV1 to forced vital capacity (FVC) of less than 70% measured after the administration of 400 mcg of salbutamol. All patients were in clinically stable condition for BODE evaluation tests. We used data from 105 patients to identify the body-mass index, the degree of airflow obstruction, the score of dyspnea and exercise capacity as assessed by the six-minute-walk-test. Then, we integrated all these variables for evaluating the severity and prognosis of COPD.
RESULTS: FEV-1 alone is useful to classify patients at different levels of disease severity but it is not a good predictor dyspnoea and may not reflect functional and the real severity GOLD stages III and IV of COPD. FEV-1 is a good predictor of unfavourable prognosis if it is correlated with a body mass index lower than 20kg/m2. 11 patients (10.47%) with BMI < 20 kg/m2 and FEV1<30% faced an immediate unfavourable prognostic and required respiratory rehabilitation.
CONCLUSIONS: In severe forms of COPD's evaluation, it is better to recommend FEV-1 evaluation with BODE index score.
CLINICAL IMPLICATIONS: The forced expiratory volume in one second (FEV-1) is a physiological variable often used to grade the severity of COPD in clinical practice. However, COPD patients may have in the same time systemic manifestations that could not be reflected by FEV-1. The BODE (Body Mass Index, airflow obstruction, dyspnea, and exercise capacity index) index is a multidimensional 10-point scale in which higher scores indicate a higher risk of bad prognosis among COPD patients.
DISCLOSURE: The following authors have nothing to disclose: Oana Arghir, Veronica Manescu, Maria Suta, Paraschiva Postolache
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