New Exam May Improve Treatment of Lung Disease

Scale looks at whole body, not just lungs, of those with COPD

WEDNESDAY, March 3, 2004 (HealthDayNews) -- An exam that looks at the whole patient, not just the lungs, can refine treatment and may prolong the lives of those with the potentially fatal condition called chronic obstructive pulmonary disease (COPD), a study finds.

COPD is actually a group of conditions in which airflow through the lungs is partially blocked, so a person finds it progressively harder to breathe. COPD now is the fourth-leading cause of death in the United States and Canada, and its toll is predicted to rise.

Yet a new study of 625 patients shows that an exam scale called the BODE index can pick out patients at highest risk of deterioration and death.

The study also shows focused treatment based on the BODE index can help save lives, says Dr. Claudia G. Cote, a pulmonary and critical care physician at the Bay Pines Veterans Administration Medical Center in Florida and a participant in the study.

"We have been taught that COPD is an irreversible, chronic condition that leads to death," she says. "But we have shown that we can improve both survival and quality of life for COPD patients."

The study appears in the March 4 issue of the New England Journal of Medicine.

The BODE index is named for the four physical characteristics it measures -- "B" for body mass index; "O" for the degree of airway obstruction; "D" for dyspnea (difficulty breathing); and "E" for exercise capacity. It was developed by study author Dr. Bartolome R. Celli, chief of pulmonary care at St. Elizabeth's Medical Center in Boston.

"It didn't come out of the blue," Celli says. "I've been seeing patients for 30 years. The medical literature suggests very simple measurements can be used to evaluate patients beyond lung function."

That overall evaluation can be critical, Cote says. "You have one patient with 30 percent lung function in a wheelchair and getting oxygen, and another with the same degree of function is hopping around and functioning fully," she says.

Determining a score on the 1-to-10 BODE index can take only a few minutes, she says. The patient fills out a questionnaire about physical characteristics, takes a test to see how far he or she can walk in six minutes, and has lung function measured by a well-known -- although not commonly used -- technique called spirometry. The doctor also obtains a body mass index reading, a ratio of height to weight that is a standard test of obesity.

Every one-point increase in the BODE index was associated with a 33 percent increased risk of death during the study, the researchers found.

"We hope this paper will allow clinicians to look at patients differently," Celli says. "We can show that walking distance can be improved, and it is conceivable that we can reduce mortality."

The American Thoracic Society is starting a campaign to have specialists use spirometry more often for all patients with COPD, Cote says.

"We're looking forward to doing it," says Dr. Stephen I. Rennard, a professor of medicine at the University of Nebraska Medical Center, and author of an accompanying editorial in the journal. "We think the BODE index is likely to be used in clinical practice. COPD may not be cured, but patients can be made better."

More information

To learn more about COPD, visit the American Lung Association and the National Library of Medicine.

SOURCES: Claudia G. Cote, pulmonary and critical care physician, Bay Pines Veterans Administration Medical Center, St. Petersburg, Fla.; Bartolome R. Celli, chief, pulmonary care, St. Elizabeth's Medical Center, Boston; Stephen I. Rennard, M.D., professor, medicine, University of Nebraska Medical Center, Omaha; March 4, 2004, New England Journal of Medicine
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