Bartolome R. Celli, Harvard Medical School, Boston, Massachusetts, USA
Chronic obstructive pulmonary disease is an important cause of disability and death around the world. The disease has been classically characterized by the presence of airflow limitation resulting from airway inflammation and remodeling as well as parenchymal destruction or emphysema. The severity and progression of chronic obstructive pulmonary disease has been classically defined by the degree of airflow limitation measured with the forced expiratory volume in one second during a forced vital capacity maneuver. However, observational and experimental studies have shown that chronic obstructive pulmonary disease is a respiratory disease associated with several systemic manifestations that actually impart a poor prognosis. Therefore it has become clear that there is a need to quantify and incorporate measurement of one or more of those dimensions in order to better reflect the actual compromise of patients. Based on findings from a large observational cohort, we determined that the body mass index (B), the severity of airflow limitation (O), degree of dyspnea (D) and the distance walked over six minutes (E) (i.e. BODE) were amongst the several clinical variables that related independently to mortality. The multidimensional BODE index developed by the integration of those variables into a single 0-10 scale has been shown to predict not only all-cause and respiratory mortality, but also to respond to interventions such as lung transplant, lung volume reduction surgery, and pulmonary rehabilitation. This monograph summarizes the information that supports the concept that the BODE index can be used to define chronic obstructive pulmonary disease severity and staging of disease. Importantly, the information available shows that BODE can serve as a surrogate marker of disease progression and response to therapy.
Keywords: BODE index. COPD. Severity. Staging.
