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Prediction of future exacerbations of chronic obstructive pulmonary disease (COPD) is a major concern for long-term management of this disease.
To determine which of three multidimensional assessment systems (the body mass index, obstruction, dyspnea, and exercise capacity [BODE] index; dyspnea, obstruction, smoking, exacerbations [DOSE] index; or...
Contexts in source publication
Context 1
... a statistically significant difference was not observed between the AUC for the previous exacerbation rate, which was 0.71, and the data of the DOSE index (P = 0.40). The results of univariate analysis of predictors of exacerbation are shown in Table 2. The predictor of exac- erbation with the greatest odds ratio (OR) by simple logistic analysis was LTOT (OR 4.17, 95% confidence interval ...
Context 2
... raises the question of whether these cases should have been excluded because these events would not be counted as event-based exacerba- tions. However, the DOSE index appeared superior even when such cases were excluded from the results (Table S2). ...
Context 3
... nine of these events were not treated with antibiotics or systemic steroids, and were therefore excluded. The results of the re-analysis from which the six patients who experienced only one untreated exacerbation were excluded are shown in Table S2; even in the absence of these ambiguous symptom-defined events, the DOSE index remained superior in this analysis. ...
Citations
... Анализ маркеров прогрессирования и прогноза у пациентов ХОБЛ имеет большое клиническое значение. Многомерные индексы имеют хорошее прогностическое значение и широко используются для оценки течения ХОБЛ и выживаемости пациентов при длительном наблюдении [31,32]. Учитывая тот факт, что обострения и коморбидные заболевания являются неотъемлемой составляющей ХОБЛ, прогностические индексы, включаю щие частоту обострений (BODEX, e-BODE, DOSE) и значимую сопутствующую патологию (CODEX), позволяют точнее оценить степень прогрессирования и прогноз для пациентов с ХОБЛ. ...
Introduction. Repeated exacerbations play a leading role in the progression of chronic obstructive pulmonary disease (COPD), contributing to an increase in the number of hospitalizations, a decrease in ventilation function of the lungs, and an increase in deaths.
Aim. To analyze the clinical efficacy of pneumococcal disease vaccine prophylaxis in patients with COPD in combination with type 2 diabetes mellitus (DM) during 5 years of follow-up.
Materials and methods. The study included patients (n = 113) with COPD and type 2 DM. The main parameters for evaluating the effectiveness of vaccination were the number of COPD exacerbations, including severe, requiring hospitalization of patients, the incidence of pneumonia, the dynamics of the severity of shortness of breath using the Modified Medical Research Council questionnaire – mMRC, the volume of forced exhalation in 1 second (FEV1), the dynamics of changes in laboratory indicators and prognostic indices BODEX, e-BODE, DOSE, ADO, CODEX. Pneumococcal conjugate 13-valent vaccine was used for vaccinoprophylaxis.
Results. It has been established that vaccination against pneumococcal disease in patients with COPD and type 2 DM allows not only to significantly reduce the number of COPD exacerbations (by 2.7 times), reduce the frequency of episodes of community-acquired pneumonia (by 8 times) and significantly reduce the number of hospitalizations, but also stabilize the main functional indicators of the respiratory system while maintaining clinical effectiveness during the 5-year follow-up period. The dynamics of prognostic indices in the group of vaccinated patients reliably confirms the effectiveness of pneumococcal disease vaccine prophylaxis programs and the survival rate of patients with a combination of COPD and type 2 DM.
Conclusion. The results of the study confirm that the vaccine prophylaxis of pneumococcal infection significantly reduces the risk of such undesirable events as exacerbations of COPD, pneumonia, hospitalization, and allows to stabilize the course of not only COPD, but also concomitant type 2 diabetes mellitus and thereby improve the prognosis for patients.
... Indices such as perception of dyspnea and exercise capacity are important in assessing disease severity and outcomes in COPD. 26,27 There was a significant positive correlation between Exercise capacity (6-minute walk distance) and PIF for Clickhaler, Autohaler, Easybreathe and pressurized Metered dose inhaler (pMDI). There was also an observed trend of a decrease in mean PIF across all the inhalers as the MMRC dyspnea scale category of the patients increased. ...
Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder that affects millions of people worldwide and inhalation therapy is central to the symptomatic management of the disease. Therefore, knowledge of the minimum Peak inspiratory flow (PIF) requirements for specific inhalers especially dry powder inhalers (DPI's) is necessary when prescribing inhalation therapy. The purpose of this study is to assess the effect of COPD severity on PIF in patients with COPD.
Methodology: A total of 150 subjects (75 patients with stable COPD, and 75 apparently healthy subjects) participated in the study. PIF was assessed using the In-check Inhaler Assessment Kit (manufactured by Clement Clarke International Ltd, Harlow, UK). Lung function was assessed by spirometry with subjects divided into four groups based on the severity of their airway obstruction using the GOLD criteria. The Modified Medical Research Council (MMRC) dyspnea scale was used to assess dyspnea severity. Exercise capacity was assessed using the 6-minute walk test. Statistical analysis was performed with SPSS 23.0 software. In all the statistical tests, a p value of <0.05 was considered significant.
Results: The mean age for the COPD patient and control population are 72.48 ± 8.01 and 70.69 ± 5.82 respectively. The control group had higher PIF than COPD group; however, only the clickhler and pMDI had statistically significant difference between the mean PIF of the patients compared with the control group. Generally, there was an observed trend of a decrease in mean PIF as the COPD stage progresses with a statistically significant difference observed for Easibreathe (F= 3.52, p= 0.019) and pressurized Metered dose inhaler (pMDI) (F= 4.26, p= 0.008). There was a significant positive correlation between FEV1%, FVC, Exercise capacity (6-minute walk distance) and PIF for Clickhaler, Autohaler, Easybreathe and pMDI. For pMDI, there was a statistically significant difference between means of PIF across the MMRC dyspnea scale with PIF decreasing with increasing severity of dyspnea (F= 2.85, p= 0.033).
Conclusion: COPD patients have slightly lower PIF than controls. Poor exercise tolerance and lower spirometric pulmonary function parameters may contribute to low PIF.
Keywords: Chronic obstructive pulmonary disease; Dry powder inhalers; Peak inspiratory flow; Pressurized Metered Dose Inhaler.
... The clinical heterogeneity of COPD phenotypes does not allow the development of a single tool for predicting disease progression and clinical outcomes; therefore, multidimensional indices assessing different clinical features of the disease have been developed. Multidimensional indices have been shown to be better predictors of survival than any of the individual indices [9,20]. Multidimensional indices have been found to have good prognostic significance and can be used to assess the course and survival of COPD in long-term follow-up. ...
(1) Background: Chronic obstructive pulmonary disease (COPD) is one of the most important respiratory diseases. It is characterised by a progressive course with individual differences in clinical presentation and prognosis. The use of multidimensional indices such as the BODE, eBODE, BODEX, CODEX, ADO, and Charlson Comorbidity Index has been proposed to predict the survival rate of COPD patients. However, there is limited research on the prognostic significance of these indices in predicting long-term survival rates in patients with COPD. The aim of this prospective cohort study was to investigate the prognostic value of the BODE, eBODE, BODEX, CODEX, ADO, COTE and Charlson Comorbidity Index in predicting 5- and 10-year survival in patients with COPD. (2) Methods: A total of 170 patients were included in the study and their clinical and functional characteristics of COPD progression, such as dyspnoea, body mass index and spirometry data, were evaluated. A Kaplan–Meier survival analysis was used to calculate 5- and 10-year survival rates. The predictive value of each index was assessed using Cox proportional hazards regression models. (3) Results: The 5-year survival rate was 62.35% and the 10-year survival rate was 34.70%. The BODE, eBODE, BODEX, CODEX, ADO, COTE and Charlson Comorbidity Index were all significantly associated with the 10-year survival rate of COPD patients (p < 0.05). The hazard ratios (HRs) for these indices were as follows: BODE (HR = 1.30, 95% confidence interval [CI] 1.21–1.39); eBODE (HR = 1.29, 95% CI 1.21–1.37); BODEX (HR = 1.48, 95% CI 1.35–1.63); CODEX (HR = 1.42, 95% CI 1.31–1.54); COTE (HR = 1.55, 95% CI 1.36–1.75); ADO (HR = 1.41, 95% CI 1.29–1.54); and Charlson Comorbidity Index (HR = 1.35, 95% CI 1.22–1.48). (4) Conclusions: The multidimensional indices are a useful clinical tool for assessing the course and prognosis of COPD. These indices can be used to identify patients at a high risk of mortality and guide the management of COPD patients.
... It was derived as a predictor of health status, 21 but also reflects mortality, future exacerbations, and decline in health status. [22][23][24] DOSE index may be the one index to meet all the criteria required of an index for use in routine primary care clinical practice, one which would provide healthcare professionals with a measure of current status and future risk in their patients with COPD. 14 Against this background, we planned to evaluate the DOSE index for future outcomes in patients with COPD and the correlation between DOSE and CAT scores. ...
... Thus, these results demonstrate that the DOSE index score is a good predictor of health status as there is a statistically significant reduction of the DOSE index score after stabilization from acute exacerbation episode which can be used to monitor the course of recovery of inpatient COPD exacerbations. Motegi et al., 23 in their 2-year prospective cohort study, enrolled stable patients with COPD, and the DOSE index score was calculated at the end of the first year based on the exacerbation frequencies during the first year of the study period. They observed that the patients who experienced exacerbations during the second year had higher DOSE index scores (2.1 ± 1.5) than those who did not experience exacerbations (0.9 ± 1.2). ...
... The mean number of exacerbations during the follow-up period of 6 months in the study group was 1.63. The mean annual exacerbation rates were 0.57 and 1.22 in studies conducted by Motegi et al. 23 and Jones et al., 21 respectively. The study of Kerkhof et al. 30 showed a mean annual exacerbation rate of 0.8 in mild COPD and 1.2-2.0 in moderate to very severe COPD. ...
Objectives: Chronic obstructive pulmonary disease (COPD) being a disease with systemic consequences necessitate the use of multidimensional indices for a comprehensive assessment of the disease’s impact including the future risk of exacerbations and mortality. To study the role of dyspnea, obstruction, smoking, and exacerbation (DOSE) index as a predictor of future disease severity and its correlation with chronic obstructive pulmonary disease test (CAT) score. Measurements and results: A total of 60 inpatients with COPD exacerbations were followed up for 6 months to record the number of exacerbations of COPD. The DOSE index and CAT score were calculated after stabilization within 48 hours of admission, at 1 week, and again at 6 months. The mean difference between DOSE index score at admission and at 1 week was 1.382 ± 0.561 and at admission and at 6 months was 2.15 ±0.988, both being statistically significant (p < 0.001). A high DOSE index score (≥4) was associated with a greater risk of 2 or more exacerbations[odds ratio (OR), 12 (3.09–46.60) and risk estimate, 3.75 (1.53–9.17)]. For the prediction of exacerbations, the area under the curve (AUC) was larger for the DOSE index (0.854) than the global initiative for chronic obstructive lung disease (GOLD) stage (0.789), p < 0.001 for both. Furthermore, DOSE index correlated significantly with the CAT score, an established health status measure, at all stages of disease severity; at the onset of exacerbation (r = 0.719, p < 0.001), after stabilization at 1 week (r = 0.736, p < 0.001) and at 6 months (r = 0.884, p < 0.001).Conclusion: The DOSE index is a simple, practical multidimensional grading tool for assessing current symptoms, health status, and future risk in COPD and acts as a guide to disease management as its component items can be modified by interventions. Its correlation with CAT, a well-known score is a novel observation, which further corroborates the validity of the DOSE index.
Keywords: Chronic obstructive pulmonary disease, Chronic obstructive pulmonary disease test, Dyspnea, Obstruction, smoking, and exacerbation index, Global initiative for chronic obstructive lung disease.
... 14 Finding a more objective, convenient and accurate index to guide the switching point has become an important clinical issue. 15 The levels of PCT, which is a small molecule, are elevated in plasma in severe bacterial, fungal and parasitic infections. PCT can therefore be used as a biomarker for bacterial infections, and it is also able to respond to the active level of inflammatory response in the body. ...
Objective:
To analyse the guiding value of procalcitonin (PCT) for the selection of ventilation switching points in sequential mechanical ventilation for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and respiratory failure, and to provide a reference for the optimisation of mechanical ventilation for patients with COPD and respiratory failure.
Methods:
The study included 160 patients with an acute exacerbation of COPD complicated by respiratory failure who received sequential mechanical ventilation treatment. They were divided into two groups of 80 participants. The critical point of the pulmonary infection observation window (PIC) was used as the switching point for sequential mechanical ventilation treatment in the control group, and PCT clinical node was used as the switching point for sequential mechanical ventilation treatment in the observation group. The invasive ventilation time, non-invasive mechanical ventilation time, total mechanical ventilation time, intensive care unit (ICU) treatment time, complication rate and prognosis were compared for the two groups.
Results:
(1) There was no significant difference in the respiratory rate, heart rate, arterial systolic pressure, arterial oxygen partial pressure, arterial carbon dioxide partial pressure or pH value between the two groups after 1 day of treatment, and (2) invasive mechanical ventilation time, non-invasive mechanical ventilation time, total mechanical ventilation time, ICU treatment time and the incidence of complications were significantly different in the two groups (P = 0.0001).
Conclusion:
Detecting PCT can guide the selection of ventilation switching points in sequential mechanical ventilation therapy for patients with COPD with respiratory failure in the acute exacerbation stage, effectively reduce the misevaluation of PIC switching points so that patients can obtain stable criteria for judgement and effectively improve the efficiency and safety of mechanical ventilation treatment for patients in the acute exacerbation stage.
... In a study comparing three multi-dimensional assessment systems, BODE index, DOSE (dyspnoea, obstruction, smoking, exacerbations) index, or ADO (age, dyspnoea, obstruction) index for predicting exacerbations, the DOSE index was a better predictor of exacerbations of COPD compared to the other two. 51 Bertens et al 52 have recently developed a prediction model for AECOPD. The final model included four easily assessable variables: exacerbations in the previous year, pack years of smoking, level of airways obstruction, and a history of vascular disease, with a C-statistic of 0.75. ...
... 1111/resp.14197 the management of patients with chronic airways disease, 95-103 neglected in these discussions was a fulsome description of the role of non-invasive and quantitative imaging measurements of lung pathologies that drive disease initiation [104][105][106][107][108][109][110][111][112] and worsening 13,45,106,[113][114][115][116][117][118] as well as symptoms, 11,12,34,[119][120][121][122][123][124] disease control 8,14,125 and quality of life. 8,125,126 In other words, pulmonary imaging has been somewhat overlooked in these schemes, even though it provides unique opportunities to sensitively measure pulmonary treatable traits that may be used to guide therapy decisions in patients with chronic lung disease. ...
Pulmonary functional MRI (PfMRI) using inhaled hyperpolarized, radiation-free gases (such as ³He and ¹²⁹Xe) provides a way to directly visualize inhaled gas distribution and ventilation defects (or ventilation heterogeneity) in real time with high spatial (~mm³) resolution. Both gases enable quantitative measurement of terminal airway morphology, while ¹²⁹Xe uniquely enables imaging the transfer of inhaled gas across the alveolar–capillary tissue barrier to the red blood cells. In patients with asthma, PfMRI abnormalities have been shown to reflect airway smooth muscle dysfunction, airway inflammation and remodelling, luminal occlusions and airway pruning. The method is rapid (8–15 s), cost-effective (~$300/scan) and very well tolerated in patients, even in those who are very young or very ill, because unlike computed tomography (CT), positron emission tomography and single-photon emission CT, there is no ionizing radiation and the examination takes only a few seconds. However, PfMRI is not without limitations, which include the requirement of complex image analysis, specialized equipment and additional training and quality control. We provide an overview of the three main applications of hyperpolarized noble gas MRI in asthma research including: (1) inhaled gas distribution or ventilation imaging, (2) alveolar microstructure and finally (3) gas transfer into the alveolar–capillary tissue space and from the tissue barrier into red blood cells in the pulmonary microvasculature. We highlight the evidence that supports a deeper understanding of the mechanisms of asthma worsening over time and the pathologies responsible for symptoms and disease control. We conclude with a summary of approaches that have the potential for integration into clinical workflows and that may be used to guide personalized treatment planning.
... The DOSE index, consisting of Dyspnoea (mMRC), Obstruction (FEV 1 %), Smoking, and Exacerbation (during the previous year), was developed with the same aim of an easy and comprehensive assessment of the patient's prognosis [72]. Nevertheless, it turned out to be accurate in predicting hospital admission, exacerbation risk [73,74] and length of hospital stay [72]. While it is also predictive of mortality risk [16], it has inferior predictive capacity compared to BODE or ADO indices [59]. ...
... DOSE, ADO and BODE indices offer accurate prognosis for stable patients. DOSE has a strong prognostic capacity for a large number of outcomes, such as risk of future exacerbations, hospitalization, length of hospital stay, health status and even mortality [72][73][74], although, ADO and BODE indices are more accurate in predicting of all-term mortality [59,65,96]. ...
Chronic obstructive pulmonary disease (COPD), a very common disease, is the third leading cause of death worldwide. Due to the significant heterogeneity of clinical phenotypes of COPD there is no single method suitable for predicting patients’ health status and outcomes, and therefore multidimensional indices, assessing different components of the disease, were developed and are recommended for clinical practice by international guidelines. Several indices have been widely accepted: BODE and its modifications, ADO, DOSE, CODEX, COTE. They differ in their composition and aim, while they are more accurate and better validated in specific settings and populations. We review the characteristics, strengths and limitations of these indices, and we discuss their role in routine management of patients with COPD, as well as in specific clinical scenarios, such as resuscitation and ceiling of care, or decisions to offer more invasive treatments. This analysis may help clinicians to use those indexes in a more practical and appropriate way.
... T h e G l o b a l I n i t i a t i v e f o r C h r o n i c O b s t r u c t i v e Lung Disease (GOLD) guidelines state that COPD also exhibits extrapulmonary comorbidities such as cardiovascular disease, metabolic disease, mental illness, and musculoskeletal system diseases. These comorbidities may contribute to the reduced quality of life, increased difficulty of treatment and increased risk of mortality in patients with COPD (52,53). More than 70% of COPD patients had at least one comorbidity. ...
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that seriously threatens human health and wellbeing, thereby representing an important public health problem. At present, it is the fourth leading cause of death worldwide, and is estimated to become the third greatest cause of death by 2030. In China, the prevalence of COPD is increasing, secondary to an increase in smoking, air pollution and an aging population, resulting in a current the mortality of COPD in China which is higher than the global average. Moreover, the disability-adjusted life year (DALY) rate of COPD in China is still relatively high, with an associated heavy economic burden to patients, their families and society. Unfortunately, current measures for treatment and prevention of COPD in China are not optimal. This primarily results from limited public awareness of COPD and pulmonary function tests amongst residents of China, and the generally poor disease-specific knowledge of primary care doctors. In recent years, a series of preventative strategies have been introduced in China across at the level of national policy, societies and associations, and scientific research. This review focuses upon both the epidemiology of COPD and the current status of preventative and treatment strategies in China.
... The death rates from COPD from 1990 to 2015 increased by 11.6%. When age-standardized, there was, however, a decrease in death rates from COPD in the high to middle income countries (−20-22%), while lower in low income countries (−1.6%). 1 Several single factors related to mortality in COPD patients have been suggested, such as dyspnea, [2][3][4] comorbidity (eg, with cardiovascular disease, lung cancer, osteoporosis, and depression 2 ), number of comorbidities, 5 body mass index (BMI), 3,6 percentage of predicted forced expiratory volume in 1 second (FEV 1 %), 2,3,6 exercise capacity, 2,3,6 COPD exacerbations, 2,3 biomarkers, 2,3 inspiratory fraction 2,3 or inspiratory capacity, 2 and anemia. 6 Dyspnea has been shown to be a better predictor of 5-year survival than FEV 1 %. 2 To improve the accuracy of predictive factors, efforts have been made to construct predictive indices. ...
... However, the present study shows that the registered reductions in respiratory function remain as predictors of mortality more than one year later. Among respiratory variables, dyspnoea, FEV 1 %, saturation, and exacerbations of COPD are well-known predictors of poor prognosis, [2][3][4]6 which is well in agreement with our findings. In addition, hospitalization, a strong surrogate variable mainly associated with COPD exacerbations and dyspnoea, is a wellknown risk factor. ...
Background
Both single factors and composite measures have been suggested to predict mortality in patients with chronic obstructive pulmonary disease (COPD) and there is a need to analyze the relative importance of each variable.
Objective
To explore the predictors of mortality for patients with COPD in relation to respiratory, cardiac, and malignant causes, as well as all causes of death.
Methods
After merging the Swedish Respiratory Tract Register (SRTR) and the Swedish Cause of Death Register, patients with respiratory, cardiac, and other causes of death were identified. Demographic and clinical variables from the deceased patients’ first registration with the SRTR were compared. Three univariable and multivariable Cox proportional hazards regression analyses were conducted for different causes of death, with time from first registration to either death or a fixed end date as dependent variable, and variables regarding demographics, respiration, and comorbidities as independent variables.
Results
In the multivariable Cox models, mortality for patients with all causes of death was predicted by older age 1.79 (CI 1.41, 2.27), lower percentage of predicted forced expiratory volume in 1 second (FEV1 %) 0.99 (CI 0.98, 0.99), lower saturation 0.92 (CI 0.86, 0.97), worse dyspnea 1.48 (CI 1.26, 1.74) (p<0.002 to p<0.001), less exercise 0.91 (CI 0.85, 0.98), and heart disease 1.53 (CI 1.06, 2.19) (both p<0.05). Mortality for patients with respiratory causes was predicted by higher age 1.67 (CI 1.05, 2.65) (p<0.05), lower FEV1% 0.98 (CI 0.97, 0.99), worse dyspnea 2.05 (CI 1.45, 2.90), and a higher number of exacerbations 1.27 (CI 1.11, 1.45) (p<0.001 in all comparisons). For patients with cardiac causes of death, mortality was predicted by lower FEV1% 0.99 (CI 0.98, 0.99) (p=0.001) and lower saturation 0.82 (CI 0.76, 0.89) (p<0.001), older age 1.46 (CI 1.02, 2.09) (p<0.05), and presence of heart disease at first registration 2.06 (CI 1.13, 3.73) (p<0.05).
Conclusion
Obstruction predicted mortality in all models and dyspnea in two models and needs to be addressed. Comorbidity with heart disease could further worsen the COPD patient’s prognosis and should be treated by a multidisciplinary team of professional specialists.
