Prognostic scoring systems are useful in clinical practice to identify patients at highest risk from death, to support decisions regarding how aggressively to intervene with therapies, or to inform decisions that palliative care is in the patient’s best interest. The scores can also be used to stratify patients for inclusion into clinical trials, the results from which will hopefully improve care and life expectancy.
The recent updates to the GOLD (Global Initiative for Chronic Obstructive Lung Disease) strategy documents on COPD have placed much more emphasis on multidimensional assessment tools and future risk reduction associated with COPD, including improved management and prevention of COPD exacerbations.1 These events are key events in the natural history of COPD and are important causes of morbidity and mortality in the condition. Some patients are especially susceptible to development of exacerbations and are termed frequent exacerbators with increased airway and systemic inflammation and worse prognosis than patients with a history of infrequent exacerbations.2 Frequent exacerbators have a higher risk of hospital admission and also recurrent exacerbations3 causing hospital readmission especially within 3 months of an index admission, which is costly for health-care services all over the world. In a large Canadian COPD database study, Suissa and colleagues4 also showed that from one hospital admission to the next, with progressive disease, the chance of readmission increases.