title: Changes in BODE Quartiles After Pulmonary Rehabilitation Do Not Predict 2-Year Survival in Patients With COPD.
abstract: OBJECTIVE
  Pulmonary rehabilitation (PR) has well documented positive effects in patients with chronic obstructive pulmonary disease (COPD). The BODE (body mass index, airflow obstruction, dyspnea, and exercise) index reflects the multicomponent nature of COPD. We aimed to determine whether changes in BODE quartiles after a PR program might affect 2-year survival and which characteristics drive changes in BODE quartiles after PR intervention.
  
  
  METHODS
  Ninety-five patients with COPD participated in a PR program. The BODE index and anxiety, depression, and quality of life questionnaires were completed before and after the PR program. Five-year survival was recorded for all patients, irrespective of changes in BODE quartiles.
  
  
  RESULTS
  Up to 62% of patients with COPD had an improvement in the BODE index, whereas 42% of patients had a change in BODE quartile. Survival did not differ between patients who did not and who did show an improvement in BODE quartiles, despite a trend in favor of the latter (log-rank P = .202). Similar results were observed for patients who did and did not demonstrate a change in the BODE index ≥2 (log-rank P = .679). Significant changes in BODE quartiles were mainly attributed to the duration of the disease, current smoking status, hospitalization rate in the previous year, and the presence of poorer quality of life, as well as to anxiety and depression at baseline.
  
  
  CONCLUSIONS
  Pulmonary rehabilitation significantly influenced the BODE index. The significant changes in BODE quartiles were associated with the duration of the disease, current smoking status, increased hospitalization rate, poorer quality of life, anxiety, and depression at baseline, but failed to predict 2-year survival.
authors.affiliation: Pulmonary Rehabilitation Centre (Drs Kavoura and Kosmas), Sotiria General Hospital of Chest Diseases, Athens, Greece; 2nd Respiratory Medicine Department (Drs Kostikas and Loukides), University of Athens Medical School, Attikon General Hospital, Athens, Greece; Psychiatric Department (Drs Tselebis and Bratis), Sotiria General Hospital of Chest Diseases, Athens, Greece; 1st Respiratory Medicine Department (Drs Alchanatis, Koulouris, and Bakakos), University of Athens Medical School, Sotiria Chest Hospital, Athens, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Kavoura
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kostikas
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tselebis
authors.forename: Dionysios
authors.initials: D
authors.lastname: Bratis
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Kosmas
authors.forename: Manos
authors.initials: M
authors.lastname: Alchanatis
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Koulouris
authors.forename: Petros
authors.initials: P
authors.lastname: Bakakos
authors.forename: Stelios
authors.initials: S
authors.lastname: Loukides
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D001007:Anxiety / Q000209:etiology; D015992:Body Mass Index; D003863:Depression / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D012720:Severity of Illness Index; D015996:Survival Rate