title: A comparison of three multidimensional indices of COPD severity as predictors of future exacerbations.
abstract: BACKGROUND
  Prediction of future exacerbations of chronic obstructive pulmonary disease (COPD) is a major concern for long-term management of this disease.
  
  
  OBJECTIVE
  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 age, dyspnea, obstruction [ADO] index) is superior for predicting exacerbations.
  
  
  METHODS
  This was a 2-year prospective cohort study of COPD patients. Pulmonary function tests, the 6-minute walk distance (6MWD), Modified Medical Respiratory Council (MMRC) dyspnea scores, chest computed-tomography measurements, and body composition were analyzed, and predictions of exacerbation by the three assessment systems were compared.
  
  
  RESULTS
  Among 183 patients who completed the study, the mean annual exacerbation rate was 0.57 events per patient year, which correlated significantly with lower predicted forced expiratory volume in 1 second (FEV1) (P < 0.001), lower transfer coefficient of the lung for carbon monoxide (%DLco/VA) (P = 0.021), lesser 6MWD (P = 0.016), higher MMRC dyspnea score (P = 0.001), higher DOSE index (P < 0.001), higher BODE index (P = 0.001), higher ADO index (P = 0.001), and greater extent of emphysema (P = 0.002). For prediction of exacerbation, the areas under the curves were larger for the DOSE index than for the BODE and ADO indices (P < 0.001). Adjusted multiple logistic regression identified the DOSE index as a significant predictor of risk of COPD exacerbation.
  
  
  CONCLUSIONS
  In this study, the DOSE index was a better predictor of exacerbations of COPD when compared with the BODE and ADO indices.
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan. mo-dr@nms.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Motegi
authors.forename: Rupert C
authors.initials: RC
authors.lastname: Jones
authors.forename: Takeo
authors.initials: T
authors.lastname: Ishii
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hattori
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kusunoki
authors.forename: Ryuko
authors.initials: R
authors.lastname: Furutate
authors.forename: Kouich
authors.initials: K
authors.lastname: Yamada
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gemma
authors.forename: Kozui
authors.initials: K
authors.lastname: Kida
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000503:physiopathology; D015331:Cohort Studies; D018450:Disease Progression; D004417:Dyspnea / Q000503:physiopathology; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects
keywords: BODE index; DOSE index; frequency of exacerbation; multidimensional assessment systems