Longitudinal assessment in COPD patients: multidimensional variability and outcomes.
The value and timing of multidimensional assessments in chronic obstructive pulmonary disease (COPD) remains unclear because there is little information about their variability and relationship to outcome. The aim of this study was to determine the progression of COPD using clinical and spirometric variability over time with mortality as the outcome. We determined the annual intra-individual variability of forced expiratory volume in 1 s (FEV1) and BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index in 403 patients with at least five measurements. The pattern was defined as "stable" if the annual change remained constant in ≥66% of the observations and "unstable" if it did not meet that threshold. We explored the minimum number of yearly observations that related to mortality in the 704 patients of the cohort. The "unstable" pattern of FEV1 was seen in 53% and 40% of patients using a threshold of 40 mL·year(-1) and 100 mL·year(-1), respectively. There was a slightly more "stable" pattern in the BODE index (62% for 1 point). A profile associated with mortality was defined by a baseline measurement followed by annual measurements for 2 years of the BODE index, but not its individual components, including FEV1 (p<0.001). Progression of COPD measured using FEV1 is inconsistent and relates poorly to outcome. Monitoring the more stable BODE index better assesses disease progression.
Hospital Universitario La Candelaria, Tenerife.
Ciro
C
Casanova
Armando
A
Aguirre-Jaíme
Juan P
JP
de Torres
Victor
V
Pinto-Plata
Rebeca
R
Baz
Jose M
JM
Marin
Miguel
M
Divo
Elizabeth
E
Cordoba
Santiago
S
Basaldua
Claudia
C
Cote
Bartolomé R
BR
Celli
D000368:Aged; D000465:Algorithms; D015992:Body Mass Index; D018450:Disease Progression; D004417:Dyspnea / Q000503:physiopathology; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012306:Risk; D012720:Severity of Illness Index; D013147:Spirometry / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome