Abstract

In order to monitor progression of COPD there is a need to develop indicators that accurately reflect observed symptoms. This information can then be used to inform treatment and also advice patients as to lifestyle changes that should be made to improve the outcome of the disease.
Assessment of the natural history of COPD has, since the classic studies of Fletcher and Peto, historically used FEV1 decline as a marker of severity (GOLD Guidelines). However, the more recent introduction of the multidimensional index BODE, derived from Body Mass Index, the degree of airflow obstruction, Medical Research Council Dyspnoea score and Exercise capacity has brought further refinement into the assessment process. This study has investigated BOD, a model whereby the exercise test is omitted. BOD was evaluated using Body Mass Index, the degree of airflow obstruction, the Medical Research Council Dyspnoea score using a cohort of 458 patients. The results show that BOD is an effective index for the measurement COPD progression.
The results also suggest that the BOD model may predicts COPD outcomes more accurately than the BODE and GOLD models. Each quartile increase of the BOD score was associated with a lower survival. The quartile with the worst BOD scores had a 10 year mortality rate of about 42% in contrast to the GOLD classification of severity where the worst stage (Grade 4) was associated with a mortality of 58%.
The Cox model was utilized to determine if the BOD model could be improved upon by the inclusion of the other factors investigated. It is also observed that addition of pack years smoking history scores (S) in BOD scores improves its accuracy by 3%.
Other factors that influence the progression of COPD have also been investigated as potential measures of disease outcome. These include: historical height, lean body mass, hand grip strength, symptoms duration, C reactive protein (CRP), assessments of health related quality of life and wellness.
IV
Studies into the concept of wellness suggest that assessment of the inner state of mind, as a means of determining wellness status, could be used to improve disease outcomes. The results suggest various stress factors, anger management and spirituality appear to play a vital role as the disease progresses and help to modify patient’s attitude, thinking and coping behaviour during illness.
This study has shown that overall there is a need to develop an indicator that measures both physical factors together with a patients’ “wellness”. BOD together with the Sunderland Respiratory Wellness Questionnaire are the first novel steps in this process.
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