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Field exercise tests
Published in Jonathan Dakin, Mark Mottershaw, Elena Kourteli, Making Sense of Lung Function Tests, 2017
Jonathan Dakin, Mark Mottershaw, Elena Kourteli
The BODE index is probably the most valuable prognostic tool for assessment of mortality for patients with COPD.52 The 6MWD is one element of the BODE index (Body mass index [BMI], Obstruction, Dyspnoea and Exercise). A 6MWD of greater than 350 m scores zero in this index and so confers no adverse prognosis (Table 14.1). The modified Medical Research Council (mMRC) scale of breathlessness is shown in Table 14.2.
Indications for lung transplantation and patient selection
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
Joshua S. Mason, Julia B. Becker, Edward R. Garrity
In 2004 Celli and colleagues released a landmark prognostication score for COPD known as the BODE index (Table 4.3), which is based on BMI (B), degree of airflow obstruction (O), dyspnea (D), and exercise capacity (E) measured by the 6-minute walk test (6MWT). This index was created by using a base of 207 patients and subsequently validated in a cohort of 625 patients. Patients with higher BODE scores were at higher risk for death, with improved concordance compared with FEV1.121 A modification of the BODE score using cardiopulmonary exercise testing with Vo2max122 did not improve prognostication, and one replacing the 6MWT with severe exacerbations performed equally well and may simplify scoring.123
Complications of Cardiac and Lung Transplantation
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Jay D. Pal, Daniel T. DeArmond, Hao Pan, Scott B. Johnson
COPD is the most common indication for lung transplantation and is reserved for patients who show clinical deterioration despite maximal medical therapy including smoking cessation, bronchodilator therapy, pulmonary rehabilitation, long-term oxygen therapy, and surgical lung volume reduction. Not all patients with COPD will experience a survival advantage after lung transplant, and careful patient selection is critical with a focus on clinical characteristics associated with decreased survival. Conditions considered to be indications for transplant referral include a history of hospitalization for COPD exacerbation with arterial blood gas demonstrating a partial pressure of carbon dioxide greater than 50 mm Hg (associated with median survival of approximately 3 years); pulmonary hypertension, cor pulmonale, or both, despite oxygen therapy; forced expiratory volume in 1 s (FEV1) <20% and diffusing capacity of the lung for carbon monoxide (DLCO) <20%; and homogeneous distribution of emphysema by lung imaging. The BODE index is an important tool in assessing predicted survival in patients with COPD based on the four parameters of body mass index, forced expiratory volume in 1 s, dyspnea score, and 6-min walk distance. Each parameter is scored 0–3 with higher scores given with increasing disease severity; a BODE score of 7–10 is associated with a median survival of approximately 3 years and as such represents an indication for transplant referral. While patients with lower BODE scores may not benefit from transplantation, they may be candidates for early lung transplant consultation.
The evaluation of cardiac functions according to chronic obstructive pulmonary disease groups
Published in The Aging Male, 2020
Onur Yazici, Sule Tas Gulen, Ufuk Eryilmaz, Imran Kurt Omurlu
The bronchodilation test was conducted 15 min after salbutamol inhalation (4 puffs, 400 μg). The test was performed by measuring FEV1 (%), FVC (%) and FEV1/FVC. The 6MWT was used to determine the functional capacity of the patient and performed by letting the patient walk for 6 minutes on a flat surface with his/her own maximum speed. The patient’s oxygen saturation was measured both before and after the 6MWT test by pulse oximetry, and dyspnea and fatigue were also recorded. All subjects underwent the 6MWT, and their data were recorded [22]. The data were used to calculate the BODE index score that is used to determine COPD-related mortality risk, wherein an increased BODE index score is associated with an increased risk of mortality. BMI, airway obstruction based on FEV1, dyspnea based on the mMRC dyspnea score, and exercise capacity based on the 6MWT are evaluated to determine the BODE index score [23].
The prognostic value of mid-regional pro-adrenomedullin in the evaluation of acute dyspnea
Published in Expert Review of Molecular Diagnostics, 2018
Justin J. Choi, Matthew W. McCarthy
MR-proADM has also been investigated as markers of long-term outcomes of COPD patients, including a study that suggested that long-term outcomes including survival and hospital admission rates had stronger associations with MR-proADM levels than short-term outcomes when following patients for up to 2 years after hospitalization for AECOPD [65,66]. There appears to be a lower short-term prognostic value when excluding patients with suspected heart failure or pneumonia, which correlates with numerous studies that demonstrate MR-proADM levels correlating with cardiovascular stress and infection. The BODE index is a multidimensional grading system and well-validated tool used to predict mortality in COPD, and pro-ADM appears to provide added value to the BODE index in a multivariable analysis that showed improved 1-year and 2-year mortality prediction when used in combination rather than using the BODE index alone [67,68].
Lung volume reduction with endobronchial valves in patients with emphysema
Published in Expert Review of Medical Devices, 2018
Marieke C. Van Der Molen, Karin Klooster, Jorine E. Hartman, Dirk-Jan Slebos
Supportive of the assumed survival benefit in patients with successful EBV treatment, is the improvement of survival predictors in the EBV group. BODE index (a score based on body mass index, airflow obstruction, dyspnea score and exercise capacity), inspiratory-to-total lung capacity ratio (being a surrogate for hyperinflation), and 6MWD are all proven predictors of risk of death. Post hoc analysis showed a significant improvement on these three endpoints at 6 months follow-up in the EBV group, where no differences were seen in the control group [32]. To date, no further studies addressed this subject and long-term follow-up data are needed to prove a real survival benefit.