Abstract

Background and Objective: The prevalence and the burden of COPD are projected to increase in the upcoming decades due to the continued exposure to COPD risk factors and changing age structure of world’s population. BODE index is a multidimensional grading system for COPD assessment which combines 4 variables and is a simple and excellent predictor of survival and mortality in COPD patients. Objectives of the study are: 1. To predict prognosis and future risk of exacerbations in COPD patients on first visit on the basis of BODE index. 2. To assess the accuracy of prediction using BODE index during the follow up visits. Materials and methods: A prospective clinical study was conducted among 40 stable COPD patients who attended or got admitted at Mandya Institute of Medical Sciences during a time period of 12 months. Spirometry is done at the time of admission. Further, the patients were observed for future exacerbations of COPD by following up of cases once in 30 days for a period of 6 months. Results: In the study, the mean age of the participants was 60 years with the standard deviation of around ±3.737 years. Majority were males and more than one third of the study participants i.e., around 35.0% had given history of presence of co-morbidities. The mean value of BODE Index obtained was 3.50 with the standard deviations of around ±21.95. Majority of the participants i.e., about 80.0% of them belonged to the Stage 2 based on GOLD Staging. The next common stage was Stage 3 followed by Stage 1. The study found statistical and positive correlation of exacerbations in COPD with both BODE Index and GOLD Staging, after 6 months. Also the exacerbations of COPD was observed each month among the participants, accordingly, only 4-6 cases had experienced exacerbations in each month, while majority of participants were feeling better. At the end of 6 months, on estimating the total number of exacerbations of COPD, majority i.e., around 47.5% of the participants had no exacerbations overall. Conclusion: The study found that BODE Index on first visit was successful in foreseeing the prognosis of the condition of the patient. Also it accurately predicted the future risk of exacerbations as it was positively correlated with the number of exacerbations in the follow up period. Even the correlation of the severity of the condition with the GOLD staging was established.

References

1. National Heart, Lung and Blood institute. Morbidity and mortality chart book on cardiovascular, lung and blood diseases. Bethesda, Maryland: Us department of health and human services, public health service, national institute of health accessed at http://www.nhlbi.nih.gov/resources/docs/cht book.htm; 2004.
2. World Health Organization. (2018). Chronic obstructive pulmonary disease (COPD). [online] Available at: http://www.who.int/mediacentre/factsheets/fs315/en/ [Accessed16 Jan. 2018].
3. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195:557-82.
4. Emil F. M. Wouters, MD, PhD, FCCP; Eva C. Creutzberg, PhD and Annemie M. W. J. Schols, PhD. Systemic effects in COPD. Chest. 2002 May;121(5 Suppl):127S-130S.
5. Ong KC, Earnest A, Lu SJ. A multidimensional grading system (BODE index) as predictor of hospitalization for COPD. Chest. 2005 Dec 1;128(6):3810-6.
6. Sarkar SK, Basuthakur S, Das SK, Das A, Das S, Choudhury S, Datta S. Evaluation of correlation of BODE index with health-related quality of life among patients with stable COPD attending a tertiary care hospital. Lung India: official organ of Indian Chest Society. 2015 Jan;32(1):24-8.
7. Cote CG, Pinto-Plata VM, Marin JM, Nekach H, Dordelly LJ, Celli BR. The modified BODE index: validation with mortality in COPD. European Respiratory Journal. 2008 Nov 1;32(5):1269-74.
8. Praveen CK, Manu M, Mohapatra AK, Pentapati KC. Power of BODE index in predicting future exacerbations of COPD: A prospective observational study in Indian population. The journal of the associations of physicians of India. 2019 Apr;67(4):14-6
9. Marin JM, Carrizo SJ, Casanova C, Martinez-Camblor P, Soriano JB, Agusti AG, Celli BR. Prediction of risk of COPD exacerbations by the BODE index. Respiratory medicine. 2009 Mar 1;103(3):373-8.
10. Celli BR, Cote CG, M.D., Jose M. Martin, M.D. et al. Body mass index, Airflow obstruction, Dyspnea severity, Exercise capacity index in chronic obstructive pulmonary disease. NEngl J Med 2004;350:1005-12.
11. William MacNee “Chronic Bronchitis and emphysema”. Crofton and Douglass Respiratory Diseases Chapter 616, edited by Anthony Seaton, Douglas Seaton, fifth edition, Blackwell Sciences, Volume – 1, 650.
12. Marin JM, Carrizo SJ, et al. Prediction of risk of COPD excacerbation by BODE index. Respir Med 2009,103:373-378.
13. Kapil Kumar Jangid, Ashwin Songara, Nikhilesh Pasari, Vandana Sharma. Evaluation of BODE index in prognosis and follow up of COPD patients. International journal of research in health sciences
14. Jindal SK, Gupta D, Aggarwal AN. Guidelines for management of chronic obstructive pulmonary disease in India: a guide for physicians (2003). Indian J Chest Dis Allied Sci 2004; 46: 137-93.
15. Stoller JK, Aboussouan LS. Alpha1-antitrypsin deficiency. Lancet 2005;365(9478):2225-36.
16. Blanco I, de Serres FJ, Fernandez-Bustillo E, Lara B, Miravitlles M. Estimated numbers and prevalence of PI*S and PI*Z alleles of alpha 1 antitrypsin deficiency in European countries. Eur Respir J 2006; 27(1):77-84.
17. Jindal SK, Aggarwal AN, Chaudhry K, Chhabra SK, D'Souza GA, Gupta D, et al. A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure. Indian J Chest Dis Allied Sci 2006;48(1):23-9.
18. Al-Fayez SF, Salleh M, Ardawi M, AZahran FM. Effects of sheesha and cigarette smoking on pulmonary function of Saudi males and females. Trop Geogr Med 1988;40(2):115-23.
19. Smith CA, Harrison DJ. Association between polymorphism in gene for microsomal epoxide hydrolase and susceptibility to emphysema. Lancet 1997;350(9078):630-3.
20. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, Department of Health and Human Services. Washington, DC, US; 2006.
21. Eisner MD, Balmes J, Katz BP, Trupin L, Yelin E, Blanc P. Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease. Environ Health Perspect 2005;4:7-15.
22. Leuenberger P, Schwartz J, Ackermann-Liebrich U, Blaser K, Bolognini G, Bongard JP, et al. Passive smoking exposure in adults and chronic respiratory symptoms (SAPALDIA Study). Swiss Study on Air Pollution and Lung Diseases in Adults, SAPALDIA Team. Am J Respir Crit Care Med 1994;150(5 Pt 1):1222-8.
23. Dayal HH, Khuder S, Sharrar R, Trieff N. Passive smoking in obstructive respiratory disease in an industrialized urban population. Environ Res 1994;65(2):161-71.
24. Balmes J, Becklake M, Blanc P, Henneberger P, Kreiss K, Mapp C, et al. American Thoracic Society Statement: Occupational contribution to the burden of airway disease. Am J Respir Crit Care Med 2003;167(5):787-97.
25. Warwick H, Doig A. Smoke the killer in the kitchen: Indoor air pollution in developing countries. ITDG Publishing, 103-105 Southampton Row, London WC1B HLD, UK 2004: URL: http://www.itdgpublishing.org.uk
26. Ezzati M. Indoor air pollution and health in developing countries. Lancet 2005;366(9480):104-6.
27. Smith KR, Mehta S, Maeusezahl-Feuz M. Indoor air-pollution from household solid fuel use. In: Ezzati M., Lopez, AD, Rodgers M., Murray CJ, eds. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization; 2004.
28. Mishra V, Dai X, Smith KR, Mika L. Maternal exposure to biomass smoke and reduced birth weight in Zimbabwe. Ann Epidemiol 2004;14(10):740-7.
29. Boman C, Forsberg B, Sandstrom T. Shedding new light on wood smoke: a risk factor for respiratory health. Eur Respir J 2006;27(3):446-7.
30. Oroczo-Levi M, Garcia -Aymerich J, Villar J, Ramirez-Sarmiento A, Anto JM, Gea J. Wood smoke exposure and risk of chronic obstructive pulmonary disease. Eur Respir J 2006;27:542-6.
31. Sezer H, Akkurt I, Guler N, Marakoglu K, Berk S. A case-control study on the effect of exposure to different substances on the development of COPD. Ann Epidemiol 2006;16(1):59-62.
32. Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease surveillance– United States, 1971-2000. MMWR Surveill Summ 2002;51(6):1-16.
33. Xu X, Weiss ST, Rijcken B, Schouten JP. Smoking, changes in smoking habits, and rate of decline in FEV1: new insight into gender differences. Eur Respir J 1994;7(6):1056-61.
34. Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994;272(19):1497-505.
35. Silverman EK, Weiss ST, Drazen JM, Chapman HA, Carey V, Campbell EJ, et al. Gender-related differences in severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;162(6):2152-8.
36. Tager IB, Segal MR, Speizer FE, Weiss ST. The natural history of forced expiratory volumes. Effect of cigarette smoking and respiratory symptoms. Am Rev Respir Dis 1988;138(4):837-49.
37. Barker DJ, Godfrey KM, Fall C, Osmond C, Winter PD, Shaheen SO. Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease. BMJ 1991;303(6804):671-5.
38. Shaheen SO, Barker DJ, Shiell AW, Crocker FJ, Wield GA, Holgate ST. The relationship between pneumonia in early childhood and impaired lung function in late adult life. Am J Respir Crit Care Med 1994;149(3 Pt 1): 616-9.
39. Prescott E, Lange P, Vestbo J. Socioeconomic status, lung function and admission to hospital for COPD: results from the Copenhagen City Heart Study. Eur Respir J 1999;13(5):1109-14.
40. Tao X, Hong CJ, Yu S, Chen B, Zhu H, Yang M. Priority among air pollution factors for preventing chronic obstructive pulmonary disease in Shanghai. Sci Total Environ 1992;127(1-2):57-67.
41. US Centers for Disease Control and Prevention. Criteria for a recommended standard: occupational exposure to respirable coal mine dust: National Institute of Occupational Safety and Health; 1995.
42. Neergaard Kv, Wirz K. U¨ ber eine Methode zur Messung der Lungenelastizita¨ t am lebenden Menschen, insbesondere beim Emphysem. Z Klin Med 1927;105:35–48.
43. Christie R. The elastic properties of the emphysematous lung and their clinical significance. J Clin Invest 1934;13:295.
44. Corbin RP, Loveland M, Martin RR, Macklem PT. A four-year followup study of lung mechanics in smokers. Am Rev Respir Dis 1979;120: 293–304.
45. Hogg J, Chu F, Utokaparch S, Woods R, Elliott W, Buzatu L, Cherniack R, Rogers R, Sciurba F, Coxson H, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 2004;350:2645–2653.
46. Laurell CB, Eriksson S. The electrophoretic alpha-globulin pattern of serum in alpha-antitrypsin deficiency. Scand J Clin Invest 1963;15:132–140.
47. Gross P, Pfitzer E, Tolker E, Babyak M, Kaschak M. Experimental emphysema: its production with papain in normal and silicotic rats. Arch Environ Health 1965;11:50–58.
48. Kuhn C, Yu S, Chraplyvy M, Linder H, Senior RM. The induction of emphysema with elastase: changes in connective tissue. Laboratory Investigation 1976;34:372–380.
49. Senior RM, Tegner H, Kuhn C, Ohlsson K, Starcher BC, Pierce JA. The induction of pulmonary emphysema induced with human leukocyte elastase. Am Rev Respir Dis 1977;116:469.
50. Janoff A, Sloan B, Weinbaum G, Damiano V, Sandhaus RA, Elias J, Kimbel P. Experimental emphysema induced with purified human neutrophil elastase: tissue localization of the instilled protease. Am Rev Respir Dis 1977;115:461.
51. Snider G, Lucey EC, Christensen TG, Stone PJ, Calore JD, Catanese A, Franzblau C. Emphysema and bronchial secretory cell metaplasia induced in hamsters by human neutrophil products. Am Rev Respir Dis 1984;129:155-160.
52. Eidelman D, Saetta MP, Ghezzo H, Wang N-S, Hoidal JR, King M, Cosio MG. Cellularity of the alveolar walls in smokers and its relation to lung destruction: functional implications. Am Rev Respir Dis 1990;141:1547-1552.
53. Finkelstein R, Fraser RS, Ghezzo H, Cosio MG. Alveolar inflammation and its relation to emphysema in smokers. Am J Respir Crit Care Med 1995;152:1666-1672.
54. Senior RM, Griffin GL, Fliszar CJ, Shapiro SD, Goldberg GI, Welgus HG. Human 92- and 72-kilodalton type IV collagenases are elastases. J Biol Chem 1991;266:7870-7875.
55. Shapiro SD, Kobayashi DK, Ley TJ. Cloning and characterization of a unique elastolytic metalloproteinase produced by human alveolar macrophages. J Biol Chem 1993;268:23824-23829.
56. Chapman HAJ, Stone OL, Vavrin Z. Degradation of fibrin and elastin by intact human alveolar macrophages in vitro. Characterization of a plasminogen acivator and its role in matrix degradation. J Clin Invest 1984;73:806-815.
57. Campbell E, Senior R, Welgus H. Extracellular matrix injury during lung inflammation. Chest 1987;92:161-167.
58. Senior RM, Griffin GL, Mecham RP. Chemotactic activity of elastin derived peptides. J Clin Invest 1980;66:859-862.
59. Kasahara Y, Tuder RM, Cool CD, Lynch DA, Flores SC, Voelkel NF. Inhibition of VEGF receptors causes lung cell apoptosis and emphysema. J Clin Invest 2000;106:1311–1319.
60. Aoshiba K, Yokohori N, Nagai A. Alveolar wall apoptosis causes lung destruction and emphysematous changes. Am J Respir Cell Mol Biol 2003;28:552–562.
61. Rahman, I, Morrison, D, Donaldson, K, et al. (1996) Systemic oxidative stress in asthma, COPD, and smokers. Am J Respir Crit Care Med 154,1055-1060.
62. Schols, AM, Buurman, WA, Staal van den Brekel, AJ, et al. (1996) Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. Thorax 51,819-824.
63. Takabatake, N, Nakamura, H, Abe, S, et al. (1999) Circulating leptin in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 159,1215-1219.
64. Engelen, MP, Schols, AM, Baken, WC, et al. (1994) Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD. Eur Respir J 7,1793-1797.
65. Schols, AM, Soeters, PB, Dingemans, AM, et al. (1993) Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis 147,1151-1156.
66. Baarends, EM, Schols, AM, Mostert, R, et al. (1997) Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease. Eur Respir J 10,2807-2813.
67. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1Workshop summary. Am J Respir Crit Care Med 2001;163:1256-1276.
68. Definitions, epidemiology, pathophysiology, diagnosis, and staging. Am J Respir Crit Care Med 1995;152:Suppl: S78-S83.
69. Siafakas NM, Vermeire P, Pride NB, et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J 1995;8:1398-1420.
70. Anthonisen NR, Wright EC, Hodgkin JE. Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 1986;133:14-20.
71. Burrows B. Predictors of loss of lung function and mortality in obstructive lung diseases. Eur Respir Rev 1991;1:340-5.
72. Domingo-Salvany A, Lamarca R, Ferrer M, et al. Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002;166:680-685.
73. Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 2002;121:1434-1440.
74. Pulmonary rehabilitation -- 1999. Am J Respir Crit Care Med 1999;159:1666-1682.
75. Li, Benoit-Connors ML, Reardon JZ, ZuWallack RL. Variables related to increased mortality following out-patient pulmonary rehabilitation. Eur Respir J 1996;9:431-435.
76. Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1791-1797.
77. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;160:1856-1861.
78. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-117.
79. Miyamoto S, Nagaya N, Satoh T, et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension: comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 2000;161:487-492.
80. Kamath S, Kumar A, Panda SK, Samanta RP. Correlation of BODE index with quality of life in stable Chronic Obstructive Pulmonary Disease (COPD) patients–A prospective study. Journal of Family Medicine and Primary Care. 2020 Nov;9(11):5606-13.