Background Prognostic variables in COPD patients are not well described, thus decision making regarding when to move away from aggressive life-sustaining treatments is challenging. This Fast Fact will review prognostication in patients with advanced COPD.
Ambulatory COPD Patients The forced expiratory volume in one second (FEV1) has traditionally been used to assess COPD severity. A FEV1 of less than 35% of the predicted value represents severe disease; 25% of these patients will die within two years and 55% by four years. A number of other studies have shown that age, low body mass index (BMI), and low PaO2 were independent predictors that correlated to reduced survival time. The BODE scale, consisting of BMI, exercise capacity, and subjective estimates of dyspnea, has been shown to help predict survival over 1-3 years (Celli 2004):
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Variable
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Points on BODE Index
|
|||
|
|
0
|
1
|
2
|
3
|
|
FEV1 (% predicted)
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≥65
|
50-64
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36-49
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≤35
|
|
Distance walked in 6 min (meters)
|
>350
|
250-349
|
150-249
|
≤149
|
|
MMRC dyspnea scale*
|
0-1
|
2
|
3
|
4
|
|
Body-mass index (BMI)
|
>21
|
≤21
|
|
|
|
BODE Index Score
|
One year mortality
|
Two year mortality
|
52 month mortality
|
|
0-2 |
2%
|
6%
|
19%
|
|
3-4 |
2%
|
8%
|
32%
|
|
4-6 |
2%
|
14%
|
40%
|
|
7-10 |
5%
|
31%
|
80%
|