Casanova Macario Ciro, de Torres Tajes Juan Pablo, Lanus Elizabeth Córdoba
Servicio de Neumología, Unidad de Investigación, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, España.
Arch Bronconeumol. 2009;45 Suppl 5:35-9. doi: 10.1016/S0300-2896(09)72953-9.
Chronic obstructive pulmonary disease (COPD) is a multidimensional disease with wide phenotypic heterogeneity that is not adequately reflected by forced expiratory volume in 1 second (FEV(1)). Assessment of patients with COPD requires analysis of multiple variables that encompass respiratory and extrapulmonary involvement. These variables should be viable in clinical practice, should not provide duplicate information, and should have an effect on the course of the disease. The BODE index (FEV(1), dyspnea, body mass index and the 6-minute walk test) is the most obvious example of this conceptual approach and its acceptance among the scientific community has grown in the last few years. Nevertheless, other aspects of the disease not included in the BODE index, such as pulmonary hyperinsufflation, exacerbations and comorbidities, have been shown to be important in COPD. Moreover, the development of new technologies could allow imaging techniques and biomarkers to be incorporated, which would in turn improve characterization of the disease and allow more specific and individually-tailored patient management. Nevertheless, the role of all these factors in the evaluation of a highly prevalent disease such as COPD remains to be defined.
慢性阻塞性肺疾病（COPD）是一种具有广泛表型异质性的多维度疾病，一秒用力呼气容积（FEV₁）并不能充分反映这一点。对COPD患者的评估需要分析多个变量，这些变量包括呼吸和肺外受累情况。这些变量在临床实践中应切实可行，不应提供重复信息，并且应对疾病进程产生影响。BODE指数（FEV₁、呼吸困难、体重指数和6分钟步行试验）是这种概念方法最明显的例子，在过去几年中，它在科学界的认可度不断提高。然而，BODE指数未涵盖的疾病其他方面，如肺过度充气、急性加重和合并症，已被证明在COPD中很重要。此外，新技术的发展可能使成像技术和生物标志物得以纳入，这反过来将改善对疾病的特征描述，并实现更具体且个性化的患者管理。然而，所有这些因素在评估像COPD这样的高流行疾病中的作用仍有待确定。
