Body mass index, airflow obstruction and dyspnea and body mass index, airflow obstruction, dyspnea scores, age and pack years-predictive properties of new multidimensional prognostic indices of chronic obstructive pulmonary disease in primary care
Khalid Ansari1, Niall Keaney2, Andrea Kay2, Monica Price3, Joan Munby4, Andrew Billett5, Sharon Haggerty5, Ian K Taylor2, Hajed Al Otaibi6
1 Department of Respiratory Care, College of Applied Medical Sciences, University of Dammam, Dammam, Kingdom of Saudi Arabia; Chest Clinic, Sunderland Royal Hospital, Sunderland, UK
2 Chest Clinic, Sunderland Royal Hospital, Sunderland, UK
3 Faculty of Applied Medicine, School of Pharmacy, Health and Wellbeing, University of Sunderland, UK
4 Department of Health and Wellbeing, Open University, UK
5 Sunderland Teaching Primary Care Trust, Sunderland, UK
6 Department of Respiratory Care, College of Applied Medical Sciences, University of Dammam, Dammam, Kingdom of Saudi Arabia
Department of Respiratory Care, College of Applied Medical Sciences, University of Dammam, Room S 3081, Health Sciences Building, King Faisal Road, PO Box: 1982, Dammam 31441, Kingdom of Saudi Arabia
Background: The assessment of the severity of chronic obstructive pulmonary disease (COPD) should involve a multidimensional approach that is now clearly shown to be better than using spirometric impairment alone. The aim of this study is to validate and compare novel tools without an exercise test and to extend prognostic value to patients with less severe impairment of Forced expiratory volume 1 s.
Methods: A prospective, observational, primary care cohort study identified 458 eligible patients recruited from the primary care clinics in the northeast of England in 1999–2002. A new prognostic indicator - body mass index, airflow obstruction and dyspnea (BOD) together with the conventional prognostic indices age, dyspnea and airflow obstruction (ADO), global initiative for chronic obstructive lung disease (GOLD) and new GOLD matrix were studied. We also sought to improve prognostication of BOD by adding age (A) and smoking history as pack years (S) to validate BODS (BOD with smoking history) and BODAS (BOD with smoking history and age) as prognostic tools and the predictive power of each was analyzed.
Results: The survival of the 458 patients was assessed after a median of 10 years when the mortality was found to be 33.6%. The novel indices BOD, BODS, and BODAS were significantly predictive for all-cause mortality in our cohort. Furthermore with ROC analysis the C statistics for BOD, BODS, and BODAS were 0.62, 0.66, and 0.72, respectively (P < 0.001 for each), whereas ADO and GOLD stages had a C statistic of 0.70 (P < 0.001) and 0.56 (P < 0.02), respectively. GOLD Matrix was not significant in this cohort.
Conclusion: BOD, BODS, and BODAS scores are validated predictors of all-cause mortality in a primary care cohort with COPD.