Borrowing from the experience of other medical fields, disease modification in COPD can be defined as any of the changes in a patient with COPD that are caused by an intervention. The changes should be maintained over time. If we accept certain patient-centered outcomes as important, changes in any of them should be conceived as disease modifying. One such intervention, lung volume reduction surgery (LVRS), was popularized by Cooper et al10as a therapy for COPD patients with primarily upper-lobe emphysema. Although the National Emphysema Treatment Trial11did not confer survival advantage to the surgical group as a whole, it resulted in differences in health status and exercise capacity in favor of LVRS and, at least in patients with upper-lobe emphysema and poor exercise capacity, a difference in survival after 3 years. It would be extremely useful if there were “surrogate” markers that could detect changes in a relatively short period of time, and that were accurate in predicting patient outcome. In this sense that marker could become a tool in monitoring disease modification. The multidimensional index BODE that includes the body mass index (B), percentage of predicted FEV1 (O), dyspnea (D), and the 6-min walk distance (E) is such a tool,12 as it predicts mortality better than FEV1. Furthermore, the variables that contribute to the index are amenable to change by interventions and thus make the BODE a potential tool to use in the evaluation of disease-modifying interventions.