BODE index, a more representative index to classify severity of chronic obstructive pulmonary disease (COPD), has been shown to improve after pulmonary rehabilitation (PR) (Cote CG. Eur Respir J 2005). That improvement was attributed mainly to improvements in chronic dyspnea and exercise capacity. Our question was whether improvement in BODE index is associated with a decrease in anxiety (ANX) and depression (DEP) and with clinically meaningful improvement in quality of life (QoL).
BODE index was calculated pre- and post-PR by assessing body mass index (BMI), obstruction (FEV1 %pred), dyspnea (modified MRC scale) and exercise capacity (6-min walking distance, 6MWD). ANX and DEP were estimated with Symptom Check List-90-R Questionnaire, while QoL was assessed through St. George's Respiratory Questionnaire (SGRQ).
In 52 consecutive COPD outpatients 49–82 years old who completed a 3-month PR program, we observed an improvement in BODE index sufficient to result in a BODE downstaging in 25 patients (Group A), while the remaining 27 patients (Group B) showed no change in BODE stage. ANX and DEP decreased significantly in both groups without any significant difference between groups. SGRQ improved in both groups, however the improvement was significantly greater (p<0.05) in Group A (from 37±5 to 24±4; p<0.01) vs Group B (from 35±6 to 29±3; p<0.05). Furthermore, the SGRQ decrease ≥4 units which corresponds to clinically important improvement in QoL was observed in 92% of Group A patients and only in 70% of Group B patients.
PR results to an improvement in BODE index and consequent downstaging in BODE staging system, which is associated with a clinically meaningful improvement in SGRQ and QoL.Importantly, anxiety and depression decrease significantly and irrespective of any influence of PR on BODE.
The already documented PR-induced improvement in BODE index reflects a significant improvement in the most important patient-focused PR outcome, such as quality of life.
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