Assessment of risk of COPD exacerbations by the multidimensional staging systems

Abstract

Chronic obstructive pulmonary disease (COPD) can become the third most common cause of death and the fourth cause of disability in the world by the year 2020. The severity of COPD is currently assessed using a single physiological measurement, the forced expiratory volume in 1 s (FEV1). COPD, however, has complex effects on other aspects of respiratory function and in many patients is associated with important systemic changes. The aim of this study is to compare multidimensional disease ratings in COPD. Methods: 158 consecutive COPD patients were enrolled into the study. The spirometric data (FEV1, FVC, FEV1/FVC), BODE index (BMI, FEV1, MRC, 6 MWD), BOD (BODE without 6 MWD), SAFE (SGRQ, Air-Flow limitation and Exercise tolerance) and H ADO (Health-Activity-Dyspnoea-Obstruction) were analyzed. Health-related quality of life was assessed by the Clinical COPD Questionnaire (CCQ) and the St. George Respiratory Questionnaire (SGRQ). Results: The cohort consisted of 78 younger patients, mean age 56.8*3.94 years and 80 older patients mean age 72.2*4.82. Patients in both groups had the similar severity of COPD by GOLD/ATS/ERS: FEV1, % was 42.7*14.44% versus 42.3*12.82% (p>0.05). Pearson correlation coefficient analysis demonstrates in COPD patients a significant positive correlation between the BODE and the rate of COPD exacerbations (in elderly r=0.45, p<0.01 and in younger r = 0.52, p < 0.01), also correlations between BOD index and exacerbations are considerable. Moreover the correlational analysis revealed the presence of positive correlation between the BODE and HRQL: the total scores of the CCQ (r=0.62, p<0.01) and SGRQ (r=0.42, p<0.01) in elderly COPD patients. SAFE (r=0.34, p<0.01) and HADO scores (r =-0.33, p<0.01) correlated weaker with the rate of COPD exacerbations in elderly. Conclusion: The BODE and BOD scores correlate stronger with rate of COPD exacerbations in elderly and young COPD patients than HADO and SAFE scores.