Kamath Sangita, Kumar Avesh, Panda Suman Kumar, Samanta Rudra Prasad
Senior Consultant, Department of General Medicine, Tata Main Hospital, Tata Steel, Jamshedpur, Jharkhand, India.
Final Year DNB Student, Department of General Medicine, Tata Main Hospital, Tata Steel, Jamshedpur, Jharkhand, India.
J Family Med Prim Care. 2020 Nov 30;9(11):5606-5613. doi: 10.4103/jfmpc.jfmpc_735_20. eCollection 2020 Nov.
BACKGROUND AND AIMS: Chronic obstructive pulmonary disease (COPD) is characterized by slow progressive deterioration of respiratory function with systemic effects which have a great impact on health-related quality of life (HRQoL). The severity of airflow limitation in COPD, as reflected by forced expiratory volume in one second (FEV1) does not represent the systemic consequences of COPD. Hence, a multidimensional grading system, BODE index (Body mass index, Airflow obstruction, Dyspnea and Exercise capacity) that assessed both the pulmonary and systemic manifestations has recently been proposed to provide useful prognostic information and predict the outcome in COPD patients. The objective of this study was to evaluate the relationship between BODE index and health-related quality of life (HRQOL) in stable COPD patients and its usefulness in predicting the disease exacerbations. MATERIALS AND METHODS: Sixty stable COPD patients who presented in the out-patient departments of Medicine and Pulmonology were recruited over one year period. We evaluated them by body-mass index, forced expiratory volume in one second (FEV1), Modified Medical Research Council dyspnea scale and six minute walk test (6MWT). BODE index was calculated using these variables. Disease duration, number of exacerbations and hospitalization in the previous year were recorded. We also administered the St. George's Respiratory Questionnaire (SGRQ) to assess the health related quality of life (HRQoL) in these patients. BODE scores were categorized into four quartiles, quartile one to four with scores of 0-2, 3-4, 5-6 and 7-10, respectively. RESULTS: According to BODE score, (16) 26.7% of patients were BODE 1, (27) 45% BODE 2, (15) 25% BODE 3 and (2) 3.3% were BODE 4. Higher BODE quartiles were associated with higher total SGRQ scores and SGRQ subscale scores (symptom, activity and impact). Very strong correlations were found between BODE quartiles and total SGRQ scores ( < 0.01). Among the components of BODE index, the decrease in the FEV1 (%predicted) and 6MWD, and the increase of MMRC dyspnea grade were associated with worsening of health status (increase in total SGRQ and SGRQ subscales). BODE index also correlated with the acute exacerbations ( < 0.0012) during one year follow-up. CONCLUSION: BODE index strongly correlated with the HRQoL and also reliably predicted acute exacerbations in stable COPD patients.
背景与目的：慢性阻塞性肺疾病（COPD）的特征是呼吸功能缓慢进行性恶化并伴有全身影响，这对健康相关生活质量（HRQoL）有很大影响。COPD气流受限的严重程度，如用一秒用力呼气容积（FEV1）所反映的，并不代表COPD的全身后果。因此，最近有人提出一种多维分级系统，即BODE指数（体重指数、气流阻塞、呼吸困难和运动能力），用于评估肺部和全身表现，以提供有用的预后信息并预测COPD患者的病情转归。本研究的目的是评估稳定期COPD患者的BODE指数与健康相关生活质量（HRQOL）之间的关系及其在预测疾病急性加重方面的作用。 材料与方法：在一年时间里招募了60例在医学和肺病科门诊就诊的稳定期COPD患者。我们通过体重指数、一秒用力呼气容积（FEV1）、改良医学研究委员会呼吸困难量表和六分钟步行试验（6MWT）对他们进行评估。使用这些变量计算BODE指数。记录疾病持续时间、前一年的急性加重次数和住院情况。我们还使用圣乔治呼吸问卷（SGRQ）来评估这些患者的健康相关生活质量（HRQoL）。BODE评分分为四个四分位数，第一至第四四分位数的分数分别为0 - 2、3 - 4、5 - 6和7 - 10。 结果：根据BODE评分，（16例）26.7%的患者为BODE 1级，（27例）45%为BODE 2级，（15例）25%为BODE 3级，（2例）3.3%为BODE 4级。较高的BODE四分位数与较高的SGRQ总分及SGRQ各子量表分数（症状、活动和影响）相关。在BODE四分位数与SGRQ总分之间发现了非常强的相关性（<0.01）。在BODE指数的各个组成部分中，FEV1（预测值%）和6MWD的降低以及MMRC呼吸困难分级的增加与健康状况恶化（SGRQ总分及SGRQ各子量表分数增加）相关。BODE指数在一年随访期间也与急性加重相关（<0.0012）。 结论：BODE指数与稳定期COPD患者的HRQoL密切相关，并且能可靠地预测急性加重情况。
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