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Background: The BODE index is generally used for predicting mortality risk of COPD patients. The BODE index included the body mass index, degree of airflow obstruction (FEV1), dyspnea (MMRC questionnaire), and exercise capacity (6-minute walk test). Exacerbation of COPD associated with decreased health related quality of life (HRQoL). HRQoL has become an important outcome in respiratory patients as proved by St.George’s Respiratory Questionnaire (SGRQ). This study aim to find the correlation between BODE index with exacerbation and quality of life of COPD patients. We hypothesized that the higher BODE index score, the more frequent exacerbation occurrence and HRQoL decreased. Methods: Prospective cohort study of COPD patients was conducted in Persahabatan Hospital in November 2010 till June 2011. This study assessed the BODE index (at baseline) and followed at 3, 6, 9 and 12 months. Patient were also examined with SGRQ at baseline and followed at 6 and 12 months. We monitored the occurrence of exacerbation every month by telephone, observed their medical record, or visited the COPD’s clinic and emergency departement. Results: Eighty-five patients were examined at baseline with mean of BODE index 4.29 and SGRQ total score 41.42%. After one year follow up 52 patients have completed examination, 29 patients have not complete examination and 4 patients died. Using t-test analysis the correlation of BODE index between single and frequent exacerbation was significant (P

Purpose: Reduced Forced vital capacity (FVC) in chronic obstructive pulmonary disease (COPD) is associated with comorbid conditions and behavior restriction. However, limited data are available for the association between reduced FVC and 6-minute walk distance (6MWD) based on COPD severity. Thus, we investigated the relationship between FVC and 6-minute walk distance (6MWD) based on COPD severity. Method: A total of 1,386 COPD patients in the Korean COPD Subgroup Study (KOCOSS) cohort were evaluated. spirometry and six-minute walk test (6MWT) performed at the time of enrollment were analyzed. Patients were divided into two groups, moderate (50%≤ FEV1 %predicted < 80%) (n=895) and severe-to-very severe (FEV1 %prediced < 50%) (n=491). We used a cubic spline model to demonstrate the non-linear relationship between predicted FVC% and 6MWD in moderate and severe-to-very severe COPD patients. Multimodal logistic regression was used to evaluate the association between FVC and short 6MWD. Result: In both moderate and severe-to-very severe COPD patients, those with reduced FVC (< 80% pred) had shorter 6MWD (< 350m in 6MWT, p

Background Chronic obstructive pulmonary disease (COPD) is associated with various comorbidities, which influence the course of COPD and worsen prognosis. Objectives The aim of this study was to analyze the comorbidities in a cohort of COPD patients in Poland during 12 months of observation. Material and methods A total of 444 COPD patients (median age: 66.1 years) in all stages of airflow limitation severity were enrolled. Medical histories and a questionnaire concerning comorbidities were analyzed at baseline and after 12 months (data of 267 patients available). Anthropometric data, pulmonary function, and body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE index) were assessed. Results No comorbidities were reported in 9 patients (2.0%), 101 patients (22.7%) had 1-2 comorbidities, 243 (54.7%) had 3-5, and 91 (20.6%) had more than 5 comorbidities. Cardiovascular diseases (CVDs) were the most frequent ones, followed by peptic ulcer, obstructive sleep apnea (OSA), diabetes, gastroesophageal reflux disease (GERD), and osteoporosis; 11 patients had a history of lung cancer. Cachexia was observed in 11 cases, overweight in 136 cases and obesity in 139 cases. The incidence of CVDs increased with time. The number of comorbidities correlated with the body mass index (BMI) and the number of hospitalizations for extra-pulmonary causes, but not with airflow limitation. The BODE index score increased with the number of comorbidities. Conclusions In a cohort of Polish COPD patients, the most frequent comorbidities were CVDs. The number of comorbidities affected the BODE index, but not airflow limitation. The BODE index is better than forced expiratory volume in 1 s (FEV1) in the rating of COPD patients' condition. The BMI correlated with the number of comorbidities as well as the number of hospitalizations for extra-pulmonary causes.

Introduction Several classification systems use different criteria when assessing COPD stages. The objective of this study was to compare the prevalence and distribution of COPD stages using Global initiative for chronic Obstructive Lung Disease (GOLD) recommendations and Latin American Thoracic Association (ALAT) guidelines in a primary-care population. Methods Subjects attending routine primary care visits, ≥40 years of age, current or former smokers or exposed to biomass, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator FEV 1 /FVC Results A total of 1743 subjects completed the interview, 1540 performed acceptable spirometry. COPD prevalence according to GOLD-2013 was 20.1% and had a U-shaped stage distribution (group A: 9.3%, B: 4.3%, C: 2.0%, D: 4.6%). According to ALAT, prevalence was 19.7% with a bell-shaped stage distribution (mild: 2.9%, moderate: 9%, severe: 5.4%, very-severe: 2.7%). Approximately 73% of patients were stratified as moderate (45.4%) or severe (27.3%) by ALAT guidelines, whereas using GOLD-2013 criteria the majority of subjects (approximately 69%) were in group A (46.3%) or group B (22.7%). BODE index score increased as COPD worsened according to ALAT stratification. This is not observed with GOLD-2013 criteria (similar values for B and C groups). Conclusions Disease stages differ under ALAT and GOLD-2013 criteria. ALAT identified a greater proportion of COPD subjects in the moderate and severe categories compared with GOLD-2013, where the majority were categorized in group A. Future evaluation of the ALAT classification should address its predictive ability in terms of hospitalizations and mortality.

Objective: To explore the effectiveness of multidisciplinary comprehensive respiratory rehabilitation in combination with non-invasive positive pressure ventilation (NIPPV) in the treatment of elderly patients with severe chronic obstructive pulmonary disease (COPD). Methods: Eighty-eight elderly patients with severe COPD who were admitted by the hospital between February 2016 and April 2017 were enrolled and grouped into a control group (n=29), intervention Group-A (n=30) and intervention Group-B (n=29) according to random sampling. Patients in the control group were given medicines and oxygen therapy; intervention Group-A was given NIPVV in addition to medicines and oxygen therapy; intervention Group-B was given multidisciplinary comprehensive respiratory rehabilitation in addition to the treatment as the intervention Group-A. Cardiopulmonary exercise testing, body mass index, BODE index score (airflow obstruction, dyspnea, and exercise capacity index), scoring of quality of life and arterial blood gas analysis were performed before treatment and in the 3rd month after treatment. Results: The maximum exercise power (Wmax), maximum oxygen uptake (VO2max), six minutes walking distance (6MWD), modified British Medical Research Council (MMRC), BODE index, score of quality of life, arterial partial pressure of carbon dioxide (PaCO2) and arterial partial pressure of oxygen (PaO2) of intervention Group-A and b were significantly improved after treatment (P

Objective: To determine the prevalence of vitamin D deficiency in patients with COPD and bronchial asthma, and the relation of vitamin D serum levels to pulmonary spirometric measures as well as other important clinical parameters that could affect quality of life in these patients. Subjects and methods: The study included 80 subjects: 30 patients with COPD and 30 patients with bronchial asthma and 20 healthy volunteers. Patients and control groups were subjected to vitamin D assay by ELISA as well as spirometric assessment. Assessment of patients with COPD was done according to GOLD guidelines 2013: using (mMRCs), CAT score, spirometric assessment of FEV1, and exacerbation assessment. They were also subjected to Combined COPD assessment and BODE index calculation. For all patients with bronchial asthma, GINA classification 2014 of bronchial asthma severity and asthma control assessment were done. Results: Statistically significant lower values of vitamin D were found in patients with COPD (11.94 ± 7.66 ng/ml) compared to patients with bronchial asthma (22.03 ± 8.19 ng/ml) with p

Introduction: The prevalence of hypogonadism in COPD patients is higher than in the general population and can range from 22 to 69%. However, the association between testosterone levels and COPD severity is controversial. The aim of the study was to evaluate the association of testosterone levels with COPD severity and to estimate the prevalence of hypogonadism in men with stable COPD. Methods: 89 men with stable COPD were included. Hypogonadism was defined by clinical criteria and low testosterone levels (Total Testosterone (TT) Results: Mean age of the patients was 66 years. Testosterone levels were lower in patients with high BODE index compared to low BODE: 2.8 vs 3.2 ng/ml (p= 0.36) for TT, 5.4 vs 6.3 pg/ml (p=0.01) for FT and 1 vs 1.21 (p=0.06) for BT. When hypogonadism was compared between high and low BODE index categories, the observed prevalence was 52% vs 40%, 65% vs 36% , and 64% vs 33% when TT, BT and FT were measured respectively. Using multiple linear regression analysis (controlled for age, Charlson Score, Body mass Index, Heart Failure and Coronary Heart Disease) we find a significant association between Bode index score and testosterone levels (beta coeff: -0.14 p=0.045). Conclusion: A higher prevalence of hypogonadism which increases with COPD severity was seen in men with stable COPD. COPD severity and testosterone levels were inversely associated. Lower free testosterone levels were seen in patients with more severe COPD.

Background Chronic obstructive pulmonary disease (COPD) is a highly heterogeneous disease and airflow limitation and symptoms only partially capture such heterogeneity. Since COPD is known to affect the production of volatile organic compounds (VOCs), we aimed to verify to which extent exhaled VOCs can characterize newly diagnosed COPD patients and changes in response to inhaled therapy. Materials and methods Fifty newly diagnosed COPD patients were consecutively recruited among those attending the pulmonary medicine outpatient clinic at 'Campus Bio-Medico' University Hospital. VOCs were collected using the Pneumopipe® and analysed by the BIONOTE electronic nose both at baseline and after 12 weeks of inhaled therapy. Patients were grouped using K-mean cluster analysis on BIONOTE responses and the obtained clusters were compared via non-parametric tests. Results We identified three clusters of subjects: (a) without remarkable comorbidities; (b) with air trapping and higher BODE index score (mean 1.2); (c) without air trapping and with a lower BODE index. Inhaled bronchodilators caused a quantitative reduction in the amound of VOCs, while inhaled steroids provided a qualitative modification of the breath profile. Conclusion VOCs patterns categorize newly diagnosed COPD subjects. VOCs production declines after bronchodilators administration and changes in quality after topic steroid treatment.

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients however data regarding left ventricle (LV) function in COPD is limited. We, in this study, aimed to evaluate the LV systolic function and its relation to BODE index in COPD patients with the utility of two-dimensional speckle tracking echocardiography (2D-STE). The study involved 125 COPD patients and 30 control subjects. All patients underwent 2D-echocardiography, pulmonary function tests and -minute walk tests. The patients were divided into four quartiles according to BODE index score. COPD patients had lower mitral annulus systolic velocity (Sm), average global longitudinal strain (GLS), average global longitudinal strain rate systolic (GLSRs), average GLSR early diastolic (GLSRe), average GLSR late diastolic (GLSRa), tricuspid annular plane systolic excursion (TAPSE) and peak systolic myocardial velocity (Sm-RV) (p0.001, p0.001, p0.001, p0.001, p0.001, p0.001 and p = 0.002 respectively) than control subjects. There were significant differences between BODE index quartiles in terms of Sm, average GLS and average GLSRs. Patients were divided into two groups according to median value of GLS (-18.6 and ≤ -18.6). BODE index quartiles were found to be independent predictors of decreased GLS in multivariate logistic regression analysis (p = 0.030). Increased BODE index was associated with impaired LV mechanics in patients with COPD.

Introdução: a reabilitação pulmonar tem sido aprovada como ferramenta de tratamento na Doença Pulmonar Obstrutiva Crônica. Ainda que existem vários programas em nosso meio, são escassos os reportes que avaliem o impacto dos mesmos. O índice Bode é uma escala multidimensional que re ete o impacto dos fatores pulmonar e extrapulmonar no prognóstico e a sobrevida; a reabilitação pulmonar melhora alguns componentes do índice. O objetivo foi descrever as mudanças na pontuação do índice BODE em pacientes com DPOC, antes e depois de assistir a um programa de Reabilitação pulmonar. Materiais e métodos: estudo descritivo, retrospectivo-longitudinal. Selecionaram-se registros preenchidos nos anos 2009-2010. Se incluíram 24 pacientes com dpoc que assistiram durante 8 semanas em um hospital nível III da cidade de Cali, Colômbia. Se realizou uma análise descritiva que incluiu frequências, medidas de tendência central e dispersão. A análise inferencial baseou-se na comparação da avaliação inicial e nal das variáveis de estudo. Resultados: a pontuação total do índice bode, a tolerância ao esforço, medida com teste de caminhada e a dispneia medida com a escala Modi ed Medical Research Council, tiveram reduções signi cativas (p>0,05). Conclusões: Se observou que a Reabilitação Pulmonar reduz a pontuação do índice BODE em pacientes com DPOC.

Background: Chronic Obstructive Pulmonary Disease (COPD) will be the 5th leading cause of disability (DALYs) and the 4th leading cause of death by 2030. Measuring the real impact of COPD using CAT (âCOPD Assessment Testâ) can complement BODE index, an indicator of mortality. Aims: To assess correlation between CAT and BODE index in COPD patients. Materials and methods: A retrospective study was conducted in a population of patients with COPD in a Respiratory Rehabilitation program. We analyzed demographic variables, variables in respiratory function â 6 min walking test (6MWT), post-BD forced expiratory volume in 1st second (FEV1%); dyspnea by mMRC scale; BODE Index and CAT. Results: The study included 50 patients â GOLD stage I (7), II (25), III (14) and IV (4), 48 men; mean age 62.6 years (±9.5), average BMI 25.8 kg/m2 (±4.8) and FEV1 57.1% (±19.6); 6MWT of 443.3 m (±61.6); 46% patients in classes 2 and 3 of mMRC scale; 84% were class 2 in BODE Index. About 80% reported slight to medium impact in CAT. CAT score and impact were correlated with BODE index score: R = 0.475, pÂ

Background: The functionality of people with Chronic Obstructive Pulmonary Disease (COPD) is affected as the disease progresses; therefore, the Pulmonary Rehabilitation (PR) has been endorsed by several studies as a tool for the treatment of this disease. However, although there are several programs RP, in our environment, there are few reports about its impact; especially in terms of functional patients. One strategy evaluation is the BODE index, which gives a multidimensional assessment of the patient, Objetive: Describe the changes in the score of the BODE index in COPD patients, before and after attending a program of 8 weeks of RP. Methods: A descriptive, retrospective-longitudinal study. information records filled out in the years 2009-2010 were selected. 24 patients with COPD who attended for 8 weeks at PR at a level III hospital in the city of Cali-Colombia included. the descriptive analysis included frequencies, measures of central tendency and dispersion was performed. The inferential analysis was based on comparing the initial and final evaluation of the study variables. Results: The total score BODE index, exercise tolerance, measured walk test (T6CM) and dyspnea measured with the Modified Medical Research Council scale (MRCM) had significant reductions (p> 0.05). The estimated four-year survival increased from 55.17% to 71.83%. Conclusions: It was observed that the RP reduces BODE score in patients with COPD.

Introduction: Muscle wasting is one of the important extrapulmonary features reflects exercise capacity and physical activity in chronic obstructive pulmonary disease (COPD). Aims and Objectives: We analyzed correlations between muscle wasting and COPD severity, quality of life, and systemic inflammatory markers. Methods: Eighty patients with COPD were enrolled. Subjects were assessed the components of the BODE index (BMI, FEV 1 , mMRC and 6MWT) for COPD severity, handgrip strength and FFM for muscle wasting, CAT (COPD assessment test) score for quality of life, serum levels of hs-CRP, IL-6, TNF-α, hs-TNF-α for inflammatory markers at the same day of outpatient clinic visit. The average values of three consecutive handgrip strengths and the FFM were compared with BODE index, CAT score, serum levels of hs-CRP, IL-6, TNF- and hs TNF-. Results: Both handgrip strength and FFM didn9t show significant correlation with BODE index score (handgrip strength: r=-0.148, p =0.189, FFM: r=-0.075, p =0.511) and CAT score (handgrip strength: r=-0.197, p =0.106, FFM: r=0.027, p =0.827). Handgrip strength showed significant correlations with mMRC (r=-0.331, p =0.003) and 6-minute walk distance(r=0.338, p =0.002). FFM showed positive correlation with serum hs-TNF- α (r = -0.288, p = 0.015). Handgrip strength presented positive correlations with serum hs-TNF- α (r= -0.309, p = 0.009) and IL-6 (r= -0.302, p = 0.006). Conclusions: Handgrip strength might be a useful method to assess the exercise capacity in COPD. Furthermore, handgrip strength showed positive correlation with systemic inflammation assessed by serum hs-TNF-α and IL-6 level.

Descriptions of time use patterns in people with chronic obstructive pulmonary disease (COPD) are scarce and the relationship between use-of-time and COPD severity remains unclear. This study aimed to describe a typical day for people with COPD and to explore the differences in time-use patterns across the Body Mass-Index, Airflow Obstruction, Dyspnoea and Exercise Capacity (BODE) index using compositional analyses. Using a cross-sectional design, 141 adults with clinically stable COPD had their demographics, objective measures of function (pulmonary, exercise capacity and physical activity), and self-reported COPD-related impairment recorded. Daily time-use compositions were derived from 24-h accelerometry and 24-h use-of-time recall interviews. Compositional multiple linear regression models were used to explore the relationship between the BODE index and 24-h time-use compositions. These models were used to predict daily time (min/d) that is spent in time-use components across the BODE index. The BODE index score was clearly associated with 24-h accelerometry (p < 0.0001) and 24-h use-of-time recall (p < 0.0001) compositions. Relative to the remaining time-use components, higher BODE index scores were associated with greater sedentary behaviour (p < 0.0001), Quiet time (p < 0.0001), Screen time (p = 0.001) and Self-care (p = 0.022), and less daily Chores (p < 0.0001) and Household administration (p = 0.015) time. As the BODE index scores increased, time-use predictions were strongly associated with decreases in Chores (up to 206 min/d), and increases in Screen (up to 156 min/d) and Quiet time (up to 131 min/d). Time-use patterns may provide a basis for planning interventions relative to the severity of COPD. Refereed/Peer-reviewed

BACKGROUND: Data on self-rated health (SRH) in patients with chronic obstructive pulmonary disease (COPD) are very limited; we therefore initiated this study to investigate the distribution of SRH and association with established parameters of disease severity. PATIENTS AND METHODS: We included 135 clinically stable patients with COPD (64 ± 8 years, 71% men, GOLD stage: II –59; III –55; IV –21) and 25 healthy control persons. SRH was evaluated using the 5-grade Likert scale (1-very poor to 5-very good). RESULTS: Patients with COPD had poorer SRH when compared with controls (3.0 ± 0.7 vs. 3.8 ± 0.6, P < 0.001). SRH decreased over GOLD stage (P = 0.016) and 27 (20%) patients reported poor or very poor SRH. In univariate analysis, GOLD stage (P = 0.022), Center for Epidemiologic Studies Depression (CES-D) score (P = 0.001), BODE index score (P < 0.001), score on the modified Medical Research Council (MMRC) dyspnea scale (P < 0.001) and 6-minute walk test (6MWT) distance (P < 0.001) determined poor or very poor SRH. In a multivariate model which included BODE index score, a CES-D score ≥ 16 (P = 0.013) and BODE index score (P = 0.012) determined poor or very poor SRH. In the model with individual components of the BODE index, a CES-D score ≥ 16 (P = 0.012), MMRC score of 3 or 4 (P = 0.019) and 6MWT distance ≤ 249 m (P = 0.019) determined poor or very poor SRH. CONCLUSION: In patients with COPD, SRH is worse than in healthy control persons and deteriorates over GOLD stage. Perception of health as poor or very poor is associated with psychological components (CES-D score) and disease severity (BODE index score, 6MWT distance and MMRC dyspnea score).

Background:Frequent exacerbations are associated with a faster decline in FEV1, impaired health status, and worse survival. Their impact and temporal relationship with other outcomes such as functional status, dyspnea, and the multidimensional body mass index, obstruction, dyspnea, exercise capacity (BODE) index remain unknown. Hypothesis:We reasoned that exacerbations affect the BODE index and its components, and that changes in the BODE index could be used to monitor the effect of exacerbations on the host. Study design:Prospective observational study in a Veterans Affairs medical center. Methods:We studied 205 patients with COPD (mean [± SD] FEV1, 43 ± 15% predicted), and recorded the body mass index, FEV1percent predicted, modified Medical Research Council dyspnea scale, 6-min walk distance, and the BODE index at baseline, during the exacerbation, and at 6, 12, and 24 months following the first episode, and documented all exacerbations for 2 years after the first acute exacerbation. Results:From the cohort, 130 patients (63%) experienced 352 exacerbations or (0.85 exacerbations per patient per year); 48 patients (23%), experienced one episode, 82 patients (40%) experienced 2 or more exacerbations, and 50 patients required hospitalization. At study entry, exacerbators had a worse mean baseline BODE index score (4.2 ± 2.1 vs 3.57 ± 2.3, respectively; p < 0.03). The BODE index score worsened by 1.38 points during the exacerbation, and remained 0.8 and 1.1 points above baseline at 1 and 2 years, respectively. There was little change in BODE index score at 2 years in nonexacerbators. Conclusion:COPD exacerbations negatively impact on the BODE index and its components. The BODE index is a sensitive tool used to assess the impact of exacerbations and to monitor COPD disease progression.

OBJECTIVE: The present study attempted to determine whether patients with chronic obstructive pulmonary disease (COPD) get the minimum daily amount of physical activity recommended in the guidelines established by the American College of Sports Medicine (ACSM), as well as to characterize the consequences of noncompliance with those guidelines. METHODS: This study involved 23 patients (median age: 61 - range, 59-69 years; FEV1: 39% of predicted - range, 34-53%; BMI: 24 kg/m2 - range, 21-27 kg/m2). The following parameters were evaluated: daily physical activity (DynaPort activity monitor); pulmonary function; muscle force; exercise tolerance; quality of life; functional status; and various indices of disease severity (GOLD, BODE and MRC). RESULTS: Based on compliance with the guidelines (minimum of 30 minutes of walking per day), 12 patients were considered "physically active", and 11 were considered "physically inactive". No significant differences were observed between the two groups in terms of age, gender, BMI, muscle force, ventilatory reserve, hyperinflation or quality of life. The inactive group presented more impaired pulmonary function and lower exercise tolerance, as well as lower MRC and BODE scores (p < 0.05). In their daily life, patients in the inactive group also walked for less time and more slowly than did those in the active group (p < 0.05). The MRC and BODE indices were superior to the GOLD index in predicting compliance with the guidelines, both presenting a specificity of 0.83, compared with 0.50 for the GOLD index. The BODE index score increased significantly with each day of inactivity. CONCLUSION: A large number of COPD patients do not walk more than 30 minutes per day and are therefore not getting the minimum daily amount of physical activity recommended by the ACSM. Inactivity correlates with a higher mortality rate. The MRC and BODE indices proved superior to the GOLD index in predicting whether patients are physically inactive in their daily lives.

The aims of this study were to investigate the relationship between sniff nasal inspiratory pressure (SNIP) and severity of chronic obstructive pulmonary disease (COPD) as defined by the BODE index, and to investigate the capacity of different SNIP cutoffs to predict a BODE index score ≥5 (i.e., worse disease severity).Thirty-eight subjects with COPD (21 men, 66 ± 8 years, forced expiratory volume in the first second (FEV(1)) 42 ± 16 % predicted) underwent assessments of SNIP, airflow limitation, body mass index (BMI), dyspnea (Medical Research Council scale), and exercise capacity (6-min walking test, 6MWT). The BODE index was calculated, and patients were separated into two groups according to the BODE quartiles (1 and 2, or 3 and 4).Patients from quartiles 3 and 4 presented lower values of SNIP than patients from quartiles 1 and 2 (73 ± 18 vs 56 ± 21 cmH(2)O, respectively; p = 0.01). There was significant and inverse correlation between SNIP and the BODE index (r = -0.62; p0.001). A logistic regression model revealed that a SNIP value below 63 cmH(2)O presented higher sensitivity and specificity (70 and 67 %, respectively) for predicting a BODE score equivalent to quartiles 3 or 4.SNIP is moderately and significantly related to COPD severity as assessed by the BODE index. Moreover, the cutoff point of 63 cmH2O showed the best combination of sensitivity and specificity for predicting worse scores in the BODE index.

The purpose of this study was to identify the relationship between nutritional status and the severity of the disease in patients with COPD in South Korea. This study used pretest data from a larger intervention study. Data were collected from March to October 2010, and 251 patients diagnosed with COPD from five hospitals in South Korea were included in the analysis. All participants were interviewed face-to-face. Actual dietary intake was measured by a 24-h dietary recall, and the body mass index (BMI), obstruction of the airway (FEV1% predicted), degree of dyspnea (modified Medical Research Council: MMRC), and exercise capacity (6min walking distance: 6MWD) (BODE) index was calculated to estimate the severity of the condition. Lower BODE index scores indicate lower risk of mortality. The data were analyzed by descriptive statistics, a χ(2) test, t-tests, analysis of variance (ANOVA), Pearson correlation, and hierarchical multiple regression using SPSS 18.0. The mean age of the participants was 66.83 years and 92.4% of the participants were men. The mean total energy intake was 1431.65kcal, and the mean BODE index score was 2.89. Total energy intake significantly explained additional variance in BODE, BMI, the severity of the perceived dyspnea, and the length of 6min walk after controlling for age, duration after diagnosed with COPD, and physical activities. The findings of this study emphasized the importance of calorie intake in the disease severity among COPD patients. Further research on the effects of nutritional intervention on the health outcomes of patients with COPD is warranted.

Introduction: Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) that require hospital admission have a major impact on the progression of disease and generate high health costs. Method: A multi-center, cross-sectional, observational study was conducted with the aim to identify factors associated with hospital admission in patients with COPD. We obtained data of socio-demographic and anthropometric characteristics, quality of life, respiratory symptoms, anxiety and depression, physical activity and pulmonary function tests. We analyzed their association with hospital admission with a multivariate analysis using a logistic regression model. Results: We analyzed 127 patients, 50 (39%) of whom had been hospitalized. 93.7% were men, mean age 67 years (SD=9) and a FEV1 of 41.9% (SD=15.3). In the first model obtained, the baseline SpO2, the BODE index and emergency room (ER) visits were associated with hospital admission and the area under the ROC curve (AUC) was 0.809. In a second model we included only variables readily available (without the 6 min walking test) and only the SpO2 and previous visits to the ER were significant with an AUC ROC 0.783. Conclusions: Hospital admission for exacerbation of COPD is associated with poor SpO2, higher BODE index score and a greater number of visits to the ER. In case you do not have the 6 min walking test, the other two variables offer a similar discriminative ability.

OBJECTIVE The present study attempted to determine whether patients with chronic obstructive pulmonary disease (COPD) get the minimum daily amount of physical activity recommended in the guidelines established by the American College of Sports Medicine (ACSM), as well as to characterize the consequences of noncompliance with those guidelines. METHODS This study involved 23 patients (median age: 61--range, 59-69 years; FEV1: 39% of predicted--range, 34-53%; BMI: 24 kg/m(2)--range, 21-27 kg/m(2)). The following parameters were evaluated: daily physical activity (DynaPort activity monitor); pulmonary function; muscle force; exercise tolerance; quality of life; functional status; and various indices of disease severity (GOLD, BODE and MRC). RESULTS Based on compliance with the guidelines (minimum of 30 minutes of walking per day), 12 patients were considered "physically active", and 11 were considered "physically inactive". No significant differences were observed between the two groups in terms of age, gender, BMI, muscle force, ventilatory reserve, hyperinflation or quality of life. The inactive group presented more impaired pulmonary function and lower exercise tolerance, as well as lower MRC and BODE scores (p < 0.05). In their daily life, patients in the inactive group also walked for less time and more slowly than did those in the active group (p < 0.05). The MRC and BODE indices were superior to the GOLD index in predicting compliance with the guidelines, both presenting a specificity of 0.83, compared with 0.50 for the GOLD index. The BODE index score increased significantly with each day of inactivity. CONCLUSION A large number of COPD patients do not walk more than 30 minutes per day and are therefore not getting the minimum daily amount of physical activity recommended by the ACSM. Inactivity correlates with a higher mortality rate. The MRC and BODE indices proved superior to the GOLD index in predicting whether patients are physically inactive in their daily lives.

Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible limitation in airflow. A physiological variable--the forced expiratory volume in one second (FEV1)--is often used to grade the severity of COPD. However, patients with COPD have systemic manifestations that are not reflected by the FEV1. We hypothesized that a multidimensional grading system that assessed the respiratory and systemic expressions of COPD would better categorize and predict outcome in these patients.We first evaluated 207 patients and found that four factors predicted the risk of death in this cohort: the body-mass index (B), the degree of airflow obstruction (O) and dyspnea (D), and exercise capacity (E), measured by the six-minute-walk test. We used these variables to construct the BODE index, a multidimensional 10-point scale in which higher scores indicate a higher risk of death. We then prospectively validated the index in a cohort of 625 patients, with death from any cause and from respiratory causes as the outcome variables.There were 25 deaths among the first 207 patients and 162 deaths (26 percent) in the validation cohort. Sixty-one percent of the deaths in the validation cohort were due to respiratory insufficiency, 14 percent to myocardial infarction, 12 percent to lung cancer, and 13 percent to other causes. Patients with higher BODE scores were at higher risk for death; the hazard ratio for death from any cause per one-point increase in the BODE score was 1.34 (95 percent confidence interval, 1.26 to 1.42; P0.001), and the hazard ratio for death from respiratory causes was 1.62 (95 percent confidence interval, 1.48 to 1.77; P0.001). The C statistic for the ability of the BODE index to predict the risk of death was larger than that for the FEV1 (0.74 vs. 0.65).The BODE index, a simple multidimensional grading system, is better than the FEV1 at predicting the risk of death from any cause and from respiratory causes among patients with COPD.