BODE Index for COPD Survival

Why Use

Widely applicable, requires no special equipment, and is simple to calculate. Better than FEV 1 alone at predicting mortality from any cause or respiratory cause. By using the mMRC Dyspnea Scale , it takes into consideration patient’s perception of symptoms. Looks at systemic manifestations of COPD by incorporating BMI and the 6 Minute Walk Test . May be a better predictor of hospitalizations for COPD compared to FEV 1 ( Ong 2005 ). May also be a better predictor of COPD exacerbations compared to FEV 1 alone ( Marin 2009 ).

When to Use

Patients with COPD, defined as >20 pack-year smoking history and FEV 1 /FVC ratio <0.7, measured 20 mins after albuterol given. Do not use if any of the following: Asthma diagnosis. Inability to perform bronchodilator test or 6 Minute Walk Test . MI within four months. Unstable angina. CHF (NYHA class III or IV). Likely to die within 3 years from a cause other than COPD. Should not be used during acute exacerbations. The DECAF Score can be used to predict mortality in acute exacerbations of COPD.

Formula

Pearls / Pitfalls

The BODE Index is a unique scoring system that uses variables from different domains to predict all-cause mortality and mortality from respiratory causes (respiratory failure, pneumonia or pulmonary embolism) in patients with COPD. Intended for use in patients with stable COPD who are already on appropriate treatment (not acute exacerbations of COPD). Requires FEV 1 , 6 Minute Walk Test , and mMRC Dyspnea Scale . Not intended to guide or influence treatment. Better than FEV 1 to predict risk of death, hospitalizations and exacerbations of COPD.

Management

The BODE Index is used to predict mortality and has not been studied to guide management.

Critical Actions

Should not be used to guide treatment. Use the BODE Index to help educate patients about their prognosis and to inform discussions regarding goals of care.

Advice

Does not predict clinical response to therapy. Does not guide therapy. Best used as an adjunct to discussions with patients regarding a realistic and evidence-based picture of their prognosis. Patients with a higher BODE Index have a higher risk of death from any cause and from respiratory causes (respiratory failure, pneumonia or pulmonary embolism). Patients with a higher BODE Index have a greater number of COPD exacerbations and hospitalizations.

More Information

Interpretation: BODE Index 4-year survival 0–2 80% 3–4 67% 5–6 57% 7–10 18% Survival estimates based on Kaplan-Meier curves from Celli 2004 :