PREDICTING EXACERBATIONS IN COPD PATIENTS USING MULTIDIMENSIONAL ASSESSMENT SYSTEMS, BASED ON GOLD STAGING CRITERIA
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Exacerbations of COPD are events in the life of people with COPD leading to fall in pulmonary functions and premature death. Prediction of such events assumes significance, since prompt identification and treatment can modify outcomes in such patients. Various assessment tools are available that can predict outcomes in COPD, but there are only few studies available from India. Aim-Aim of this study was to assess COPD exacerbation in various severity groups as per GOLD 2013 criteria
... OLD 2013 criteria and to find out which of the three multidimensional assessment systems, BODE index, DOSE index or ADO index is better in predicting exacerbations. MATERIALS AND METHODS This is a prospective cohort study carried out in a tertiary care teaching hospital in North Kerala from January 2014 to June 2015. Study population includes COPD patients attending the OPD or inpatients stabilised after admission to the hospital, and they were followed up monthly for 1 year. Data on the outcome measures and associated factors were collected in a stable state and predictions of exacerbation by the three assessment systems were compared. Statistical analysis was done using SPSS software version 18. RESULTS Out of 300 patients included in the study, 12 (4%) lost followup and 24 (8%) died during the study period. Of the total patients, 62 (20.7%) were belonging to the group B and 238 (79.3%) in the group D of 2013 GOLD staging criteria. The mean annual exacerbation rate was 2.8 events per patients per year. Rate of exacerbation correlated with lower predicted forced expiratory volume in 1 second (FEV1), lesser 6 MWD, higher mMRC dyspnoea score, GOLD stage D, higher DOSE index, higher BODE index and higher ADO index. For prediction of exacerbations, the area under curve was larger for BODE index than for DOSE & ADO index, all these findings being statistically significant. CONCLUSION Multidimensional assessment tools, DOSE, ADO and BODE index can be used to predict exacerbations in COPD in Indian patients. BODE index was a better predictor of COPD exacerbation, compared to DOSE and ADO index.