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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    BODE Index for COPD Survival

    Predicts survival in COPD patients.
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    INSTRUCTIONS

    Do not use in patients during acute exacerbations of COPD. Do not use to guide therapy. See When to Use for full exclusion criteria.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients with COPD, defined as >20 pack-year smoking history and FEV1/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.
    • 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 FEV1, 6 Minute Walk Test, and mMRC Dyspnea Scale.
    • Not intended to guide or influence treatment. 
    • Better than FEV1 to predict risk of death, hospitalizations and exacerbations of COPD.
    • Widely applicable, requires no special equipment, and is simple to calculate.
    • Better than FEV1 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 FEV1 (Ong 2005).
    • May also be a better predictor of COPD exacerbations compared to FEV1 alone (Marin 2009).
    ≥65%
    0
    50-64%
    +1
    36-49%
    +2
    ≤35%
    +3
    ≥350 m (383 yds)
    0
    250-349 m (273-382 yds)
    +1
    150-249 m (164-272 yds)
    +2
    ≤149 m (163 yds)
    +3
    Dyspnea only with strenuous exercise
    0
    Dyspnea when hurrying or walking up a slight hill
    0
    Walks slower than people of same age because of dyspnea or stops for breath when walking at own pace
    +1
    Stops for breath after walking 100 yards (91 m) or after a few minutes
    +2
    Too dyspneic to leave house or breathless when dressing
    +3
    >21
    0
    ≤21
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.

    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.
    Content Contributors
    Reviewed By
    • Robyn Scatena, MD
    About the Creator
    Dr. Bartolome R. Celli
    Content Contributors
    Reviewed By
    • Robyn Scatena, MD