www.pneumonologia.viamedica.pl EDUKACJA 305 Adres do korespondecji: Adres do korespondecji: Adres do korespondecji: Adres do korespondecji: Adres do korespondecji: Claudia G. Cote, MD, Bay Pines VA Health Care System, 111 A — PO BOX 5005, Bay Pines, FL 33744, phone: (727) 398–6661, fax: (727) 398–9549, e-mail: claudia.cote@med.va.gov Praca wpłynęła do Redakcji: 28.01.2009 r. Copyright © 2009 Via Medica ISSN 0867–7077 Claudia G. Cote 1 , Bartolome R. Celli 2 1 Associate Professor of Medicine, University of South Florida, Medical Director, Pulmonary Rehabilitation Program, Bay Pines Veterans Administration Health Care System, Bay Pines. Floryda, Stany Zjednoczone 2 Professor of Medicine, Tuft University Medical School and Chief Pulmonary and Critical Care, Caritas St. Elizabeth’s Medical Center, Boston. Massachusetts, Stany Zjednoczone BODE index: a new tool to stage and monitor progression of chronic obstructive pulmonary disease Wskaźnik BODE: nowe narzędzie do stopniowania ciężkości i śledzenia postępu przewlekłej obturacyjnej choroby płuc Pneumonol. Alergol. Pol. 2009; 77: 305–313 Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortali- ty in adults and currently represents the fourth leading cause of death in the world [1]. It has be- come a major and growing health problem with a mortality rate that continues to increase [2–5]. COPD is the only leading cause of death showing increases in prevalence worldwide and it is expec- ted that by the year 2020, COPD will become the third leading cause of death in adults [2]. In the United States, the age-adjusted (2005 U.S. Standard Population) mortality rates for COPD has increased from 25.6 per 100 000 in 1979 to 43.5 per 100 000 in 2005 [6]. Although age-adjusted mortality rates in males have slowly declined over the last few years (55.8 per 100 000 in 2000 to 52.3 per 100 000 in 2003), for fe- males the rates have remained unchanged (37.4 per 100 000 in 2000 to 37.8 per 100 000 in 2003) [7], and for the last 3 consecutive years, COPD mortality in women has surpassed that of men, claiming the li- ves of 63 000 women in contrast to 59 000 men [6]. Although COPD is primarily characterized by the presence of airflow limitation secondary to chronic bronchitis, emphysema or both, the many systemic manifestations that accompany this dise- ase can effectively signal an increased risk for mor- tality. Recognizing and quantifying these manife- stations provides a more comprehensive asses- sment of disease severity and helps elucidate pro- gnosis. Several factors, including forced expirato- ry volume in one second (FEV 1 ), airways hyper-re- sponsiveness, severity of dyspnea, gas exchange disturbances, lung hyperinflation, pulmonary hy- pertension, malnutrition, impaired exercise capa- city and health-related quality of life, anemia, and other co-morbidities have been identified as indi- vidual variables associated with mortality in COPD. In this monograph, we will review these individual predictors for mortality. We will also discuss the ability of the BODE multidimensional index com- posed of: the body mass index (B), degree of airflow obstruction (O), level of functional dyspnea (D) and exercise capacity (E) to better stage COPD severity and to monitor and assess its response to therapeu- tic interventions and to exacerbations. Disease staging A stage in medicine relates to a level, a degree, or a period of time in the course of a process. As it relates to COPD, the staging has been arbitrarily