The Importance of Early Diagnosis and Smoking Cessation
If diagnosed early enough and a person quits smoking, COPD prognosis is relatively favorable and lung function decline is similar to anyone else of the same sex, age, height and weight. It is only when a person continues to smoke that lung function decline progresses at a much faster rate, which ultimately shortens COPD life expectancy.
Although clinical evidence is limited regarding the prognosis of COPD (meaning how long people live after diagnosis), the BODE Index has been developed as a practical tool to measure a patient's degree of lung impairment, capture their perception of respiratory symptoms, and express how the disease negatively affects the entire body as a system.
The BODE Index takes into account body mass index (BMI), airway obstruction (as measured by FEV1), dyspnea (as measured by the MMRC dyspnea scale) and exercise tolerance (as measured by the 6-minute walk test). In addition, researchers say the BODE Index is a better predictor of COPD mortality than FEV1 alone.
A table picturing the BODE Index is presented at the bottom of this page. Presumably, a higher BODE score correlates with an increased risk of death. It is important for COPD patients to understand that the BODE Index is meant to be used as a tool for informational purposes only. It should not replace the advice of a health care professional.
Understanding the BODE Index
The following details each variable of the BODE Index along with some examples of research supporting the concept. The good thing about understanding the BODE Index is that with understanding comes the ability to do something about those aspects of your life that don't support a healthy lifestyle.
Airway ObstructionThe degree of airway obstruction that is present in COPD patients is measured by a simple pulmonary function test known as spirometry. One part of the test measures forced expiratory volume in one second, or FEV1. There are numerous studies which confirm that FEV1 is a strong predictor of survival in the COPD patient. In one such study involving 270 patients (232 were COPD patients with low oxygen levels and severe airway obstruction) who received long term oxygen therapy, overall survival was poor: 70, 50 and 43 percent at 1, 2 and 3 years respectively. This means that 70% of the patients studied were still alive after 1 year, 50% at 2 years and only 43% at 3 years.
How can COPD patients slow lung function decline and prevent airway obstruction from worsening? Here are some helpful tips:
- Quit smoking -- quitting smoking is the single most effective (and least expensive) way to prevent COPD and/or slow the progression of the disease.
- Avoid secondhand smoke -- a known airway irritant, secondhand smoke is a risk factor for the development of COPD.
Body Mass Index
Body mass index, or BMI, is a tool that that allows you to measure the amount of body fat you have in relation to your height and weight. Low BMI (being too thin) has been associated with poor prognosis in patients with COPD.
What are some steps that you can increase your body weight if you are too thin? Check out the following links:
Dyspnea reflects a patient's perception of their own COPD symptoms and the degree to which one experiences dyspnea can actually be measured on a scale (the MMRC goes from 0 being the least breathless to 4 being the most). While FEV1 has previously been regarded as the best way to predict COPD mortality, there is some evidence that a patient's dyspnea level is even more significant when predicting survival than is FEV1. It is for this reason that some researchers believe that dyspnea should be included, in addition to FEV1, when evaluating COPD mortality.
How can you improve your breathing and decrease your level of dyspnea? The following links may help:
Exercise ToleranceCOPD, especially in its later stages, can dramatically affect a patient's ability to exercise. Reduced exercise tolerance is often measured in patients with chronic illness by the 6-minute walk test, and, along with BMI, is a factor that expresses the consequences of COPD that go beyond lung damage. Some evidence suggests that reduced exercise tolerance alone, can predict the risk of death in patients with certain chronic diseases, such as COPD, CHF and pulmonary hypertension.
How can you increase your exercise tolerance? Here are some tips:
- Strategies for Improving Exercise Tolerance in COPD
- Improve Activity Tolerance With Pulmonary Rehabilitation
- The Basics of Exercising With COPD
- The Benefits of Walking for COPD Patients
- 4 Ways to Increase Your Flexibility
Smoking and Life Expectancy
Continuing to smoke, especially when you have COPD, is extremely damaging to the lungs and will almost certainly shorten your life. This is supported by countless scientific data. One such study suggested only a modest reduction in COPD life expectancy in people who never smoked, but reported a very large reduction for current and former smokers. In fact, in males 65 years old who currently smoke, the reduction in years lived for stages 1, 2, 3 or 4 was 0.3 years, 2.2 years, and 5.8 years respectively. This is in addition to the 3.5 years of life lost due to smoking. In former smokers, the reductions were 1.4 years and 5.6 years for stage 2 and stages 3 or 4 COPD, and in individuals who have never smoked, they were 0.7 and 1.3 years.
For more information on quitting smoking, read the following and visit About.com's Smoking Cessation Guide Site:
A Last Word About COPD Life Expectancy
How many times have we heard stories about people who are told they only have 6 months to live, only to end up beating the odds and living for years beyond anyone's expectation? It's true that health care providers use tools such as the BODE Index to try and predict COPD life expectancy, but a prediction is but a reasoning of the future, and not always accurate. If a patient meets a COPD diagnosis with will and determination and they implement necessary lifestyle changes that will ultimately improve their health, then they may have the ability to alter the course, and therefore prognosis, of the disease.
The BODE Index (Simplified)
|Variable||Points on BODE Index|
|FEV1 (% predicted)||≥65||50-64||36-49||≤35|
|6-Minute Walk Test (meters)||≥350||250-349||150-249||≤149|
|MMRC Dyspnea Scale||0-1||2||3||4|
|Body Mass Index||>21||≤21|
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Nishimura, Koichi MD., Izumi, Takateru, MD, FCCP, Tsukino, Mitsuhiro, MD, Oga, Toru, MD, and on Behalf of the Kansai COPD Registry and Research Group in Japan. Dyspnea Is a Better Predictor of 5-Year Survival Than Airway Obstruction in Patients With COPDCHEST May 2002 Vol. 121 No. 5 1434-1440.
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