How the BODE Index Can Help Predict COPD Mortality (2022)

COPD

By

Deborah Leader, RN

Deborah Leader, RN

Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD.

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Updated on July 22, 2022

Medically reviewed

Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.

by

Daniel More, MD

How the BODE Index Can Help Predict COPD Mortality (1)

Medically reviewed byDaniel More, MD

Daniel More, MD, is a board-certified allergist and clinical immunologist with a background in internal medicine.

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(Video) BODE index for COPD

The BODE index is a tool that is used by healthcare professionals to predict the mortality rate (death rate) from chronic obstructive pulmonary disease (COPD). Using points based on four different measures of lung function, the BODE score makes a prediction about how long someone will live after a diagnosis of COPD.

How the BODE Index Can Help Predict COPD Mortality (2)

The 4 Factors in the BODE Index

Four different factors are evaluated as part of the BODE index. The reason for this index is that each of these factors can make some prediction about the prognosis of COPD, but added together the prediction is more accurate. The letters stand for:

  • Body Mass Index (BMI) is a calculation made by comparing height vs weight.
  • Airway Obstruction: Airway obstruction is measured by evaluating FEV1— the amount of air that can be forcefully exhaled in one second after a deep breath.
  • Dyspnea refers to the degree of breathlessness someone experiences while living with COPD.
  • Exercise tolerance refers to how well someone does on a 6-minute walk test.

Let's look at each of these measures separately, and then put them together in measuring the BODE index.

B - Body Mass Index

BMI is a calculation that is made by comparing height in meters by weight in kilograms.There are calculators for determining BMI, as well as tablesBMI is an estimate of how overweight or underweight a person is. With COPD, being underweight or malnourished is a poor sign when it comes to prognosis.

Body Mass Index (BMI) is a dated, flawed measure. It does not take into account factors such as body composition, ethnicity, sex, race, and age.


Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

O - Airway Obstruction

Forced expiratory volume in one second (FEV1) is a measure of the amount of air that can be forcefully exhaled in one second. The forced vital capacity (FVC) measurement shows the amount of air a person can forcefully and quickly exhale after taking a deep breath. Theratio FEV1/FVC, therefore, represents the total percentage of air that can be exhaled in one second. A normal FEV1/FVC ratio in adults is 0.70 or greater, while in children a normal ratio is 0.80 or greater. If there is anobstruction in the airways slowing or preventing this rapid exhalation of air, the ratio decreases.

D - Dyspnea

Dyspnea is the term that refers to the physical sensation of shortness of breath or breathlessness.Doctors may distinctions based on what someone may need to do —how active they are—before they become short of breath. At first, a person may only become breathless if they walk 5 miles. Later on, in COPD a person may note breathlessness with any movement at all. The modified Medical Research Council dyspnea scale (mMRC) is frequently used to evaluate dyspnea related to COPD. In this measurement, breathlessness is measured on a scale of 0 to 4:

  • mMRC Grade 0: Breathless with only strenuous exercise
  • mMRC Grade 1: Short of breath when hurrying or walking up a slight hill
  • mMRC Grade 2: Walks slower than peers on level ground because of breathlessness or has to stop for breath when walking at own pace
  • mMRC Grade 3: Stops for breath after walking 100 meters or after a few minutes
  • mMRC Grade 4: Too breathless to leave the house or breathless when dressing or undressing

E - Exercise Tolerance

Exercise tolerance refers to how active someone is able to be with the restrictions put forth by their lung disease. A test called a 6-minute walk test is used to obtain the value for the BODE index.

Values and Ranges

The following values are those that can be assigned to determine the BODE index. Note that a score can range from 0 to 10 total depending on how these add up.

(Video) BODE index -prognostic scale for COPD

VariablePoints on BODE IndexPoints on BODE IndexPoints on BODE IndexPoints on BODE Index
0123
FEV1 (% of predicted)≥6550-6436-49≤35
Distance walked in 6 minutes (meters)≥350250-349150-249≤149
mMRC dyspnea scale0-1234
BMI>21≤21

Predicting Mortality

After obtaining a BODE index, mortality can be predicted. Please note that there are many other factors that can affect mortality in people with COPD, and this test is not perfect. Someone with a very high score could end up living for decades and someone with a low score could pass tomorrow. Tests like this are good for making general predictions and evaluating statistics, but they do not necessarily give predictive information for individual people.

Survival Rates

Approximate 4-year survival rates based on the BODE index point system above is as follows:

  • 0-2 points: 80%
  • 3-4 points: 67%
  • 5-6 points: 57%
  • 7-10 points: 18%

Life Expectancy

The BODE index is one generalized measurement but survival varies tremendously when talking about individual people. Learn about some of the factors which influence COPD expectancy along with what you can do to improve your personal survival chance. If your disease is worsening, you may wish to learn as well about what you can expect with end-stage COPD.

NOTE: The BODE Index is meant to be used as a tool, for informational purposes only. It should not replace the advice of a healthcare professional.

7 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005-1012. doi:10.1056/NEJMoa021322

  2. Ansari K, Keaney N, Kay A, et al. 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. Ann Thorac Med. 2016;11(4):261-268. doi:10.4103/1817-1737.191866

  3. Eriksson B, Backman H, Bossios A, et al. Only severe COPD is associated with being underweight: results from a population survey. ERJ Open Res. 2016;2(3). doi:10.1183/23120541.00051-2015

  4. Johnson JD, Theurer WM. A stepwise approach to the interpretation of pulmonary function tests. Am Fam Physician. 2014;89(5):359-366.

  5. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54:581-586. doi:10.1136/thx.54.7.581

  6. Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428-1446. doi:10.1183/09031936.00150314

  7. Ko FWS, Tam W, Tung AHM, et al. A longitudinal study of serial BODE indices in predicting mortality and readmissions for COPD. Respir Med. 2011;105(2):266-273. doi:10.1016/j.rmed.2010.06.022

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FAQs

What is the BODE index for COPD? ›

The BODE index is a multidimensional index of disease severity in COPD that incorporates four independent predictors: the body mass index (BMI), the degree of airflow obstruction assessed by the Forced Expiratory Volume in one second (FEV1), the modified Medical Research Council (mMRC) dyspnea scale, and the exercise ...

What is the BODE index used for? ›

3 The BODE index is a scoring system which uses variables including body-mass index, degree of airway obstruction, dyspnea, and exercise capacity to predict survival in COPD patients.

What is the most important predictor of COPD exacerbation? ›

A history of exacerbations was the most important predictor of future COPD exacerbations. The risk of exacerbation increased if severe exacerbations occurred within the last 180 days and increased with the number of severe exacerbations in the patient's entire health history.

What is the Bode test? ›

The BODE Index is a unique scoring system that uses variables from different domains to predict all-cause mortality and mortality from respiratory causes (respiratory failure, pneumonia or pulmonary embolism) in patients with COPD.

How do you read a BODE index? ›

The variables were graded 0 to 3 (0 or 1 for BMI) and summed to give a total score between 0 and 10. This score was called the BODE index, with higher scores indicating a greater risk of death. The index was then prospectively evaluated in a cohort of 625 patients.

What does a BODE score of 5 mean? ›

A BODE score of 0 to 2 points is associated with 80% survival; A score of 3 to 4 points - 67% survival; A score of 5 to 6 points - 57% survival; and. A score of 7 to 10 points - 18% survival.

Which index best shows bronchial obstruction? ›

The BODE index, a simple multidimensional grading system, is better than the FEV1 at predicting the risk of death from any cause and from respiratory causes among patients with COPD.

What is the St George's respiratory Questionnaire? ›

George's Respiratory Questionnaire (SGRQ) Type of questionnaire-description. Disease-specific instrument designed to measure impact on overall health, daily life, and perceived well-being in patients with obstructive airways disease.

What is FEV1 in spirometry? ›

For instance, forced expiratory volume in 1 second (FEV1) is the maximum amount of air that the subject can forcibly expel during the first second following maximal inhalation.[2] Similarly, forced expiratory volume in 6 seconds (FEV6) is the volume of forcibly exhaled air measured during 6 seconds.[3]

How do you assess severity of COPD exacerbation? ›

The American Thoracic Society/European Respiratory Society severity scale can be used in the assessment of exacerbations: level I (mild) patient is treated at home; level II (moderate) patient requires hospitalization; and level III (severe) exacerbation leads to respiratory failure, one of the indications for ...

What are the 4 major risk factors of COPD? ›

Risk factors for COPD include:
  • Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. ...
  • People with asthma. ...
  • Occupational exposure to dusts and chemicals. ...
  • Exposure to fumes from burning fuel. ...
  • Genetics.
15 Apr 2020

How do you assess a patient with COPD exacerbation? ›

A simple and pragmatic way to diagnose an exacerbation would be to look for an increase in these symptoms - for example, the patient may notice that they are more short of breath than usual or they are producing more sputum or that sputum is more purulent.

Which test of aerobic functional capacity is most suitable for an individual with COPD? ›

The most recognized test is the self-paced 6-minute-walk test (7, 19–21), which has been used in many clinical trials of pulmonary rehabilitation in COPD (22).

What is the prognosis of COPD? ›

Chronic obstructive pulmonary disease (COPD) is a basically benign disease, but the prognosis is so poor that the mortality rate is similar to some malignant diseases. Depending on the disease severity, the 5-year mortality rate of patients with COPD varies from 40 to 70%.

What are the stages of COPD? ›

There are four distinct stages of COPD: mild, moderate, severe, and very severe. Your physician will determine your stage based on results from a breathing test called a spirometry, which assesses lung function by measuring how much air you can breathe in and out and how quickly and easily you can exhale.

How does emphysema affect the respiratory system? ›

In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

What causes cor pulmonale? ›

High blood pressure in the arteries of the lungs is called pulmonary hypertension. It is the most common cause of cor pulmonale. In people who have pulmonary hypertension, changes in the small blood vessels inside the lungs can lead to increased blood pressure in the right side of the heart.

How do they diagnose COPD? ›

a blood oxygen test – a peg-like device is attached to your finger to measure the level of oxygen in your blood. a CT scan – a detailed scan that can help identify any problems in your lungs. a phlegm sample – a sample of your phlegm (sputum) may be tested to check for signs of a chest infection.

How does COPD get diagnosed? ›

COPD is diagnosed using a simple breathing test called spirometry.

How do you monitor COPD? ›

Tests may include:
  1. Lung (pulmonary) function tests. These tests measure the amount of air you can inhale and exhale, and whether your lungs deliver enough oxygen to your blood. ...
  2. Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD . ...
  3. CT scan. ...
  4. Arterial blood gas analysis. ...
  5. Laboratory tests.
15 Apr 2020

How many items are in Sgrq? ›

Two questionnaires for asthma and COPD, one COPD specific questionnaire and one for left ventricular failure have been developed at St George's, University of London. The SGRQ questionnaire has 50 items with 76 weighted responses.

What is a normal FEV1 value? ›

The normal value for the FEV1/FVC ratio is 70% (and 65% in persons older than age 65). When compared to the reference value, a lower measured value corresponds to a more severe lung abnormality.

What is FEV1 a useful measure of? ›

Forced expiratory volume (FEV1) is a measurement taken from a pulmonary function test. It calculates the amount of air that a person can force out of their lungs in 1 second. Working out a person's FEV1 value can help diagnose chronic lung diseases, such as chronic obstructive pulmonary disease (COPD).

What is a normal FEV1 volume? ›

Volume of First Second of Exhalation (FEV1)

For males, age 20-60 normal values range from 3.5 to 4.5 liters. For females 20-60, the normal range is 2.5 to 3.25 liters. The predictive column is expressed as a percentage of predicted values. Again between 80 and 120% is considered normal.

What is FEV1 in spirometry? ›

For instance, forced expiratory volume in 1 second (FEV1) is the maximum amount of air that the subject can forcibly expel during the first second following maximal inhalation.[2] Similarly, forced expiratory volume in 6 seconds (FEV6) is the volume of forcibly exhaled air measured during 6 seconds.[3]

What are the stages of COPD? ›

There are four distinct stages of COPD: mild, moderate, severe, and very severe. Your physician will determine your stage based on results from a breathing test called a spirometry, which assesses lung function by measuring how much air you can breathe in and out and how quickly and easily you can exhale.

What is Dyspneic index? ›

Conclusions: The DI is an effective and efficient instrument to quantify patients' symptoms of upper airway dyspnea. It is a statistically robust index, with significant reliability and validity, and can be dependably used as a treatment outcome measure.

Which test of aerobic functional capacity is most suitable for an individual with COPD? ›

The most recognized test is the self-paced 6-minute-walk test (7, 19–21), which has been used in many clinical trials of pulmonary rehabilitation in COPD (22).

What is a normal FEV1 value? ›

The normal value for the FEV1/FVC ratio is 70% (and 65% in persons older than age 65). When compared to the reference value, a lower measured value corresponds to a more severe lung abnormality.

What is FEV1 a useful measure of? ›

Forced expiratory volume (FEV1) is a measurement taken from a pulmonary function test. It calculates the amount of air that a person can force out of their lungs in 1 second. Working out a person's FEV1 value can help diagnose chronic lung diseases, such as chronic obstructive pulmonary disease (COPD).

What is a normal FEV1 volume? ›

Volume of First Second of Exhalation (FEV1)

For males, age 20-60 normal values range from 3.5 to 4.5 liters. For females 20-60, the normal range is 2.5 to 3.25 liters. The predictive column is expressed as a percentage of predicted values. Again between 80 and 120% is considered normal.

What is the most common cause of death in COPD? ›

In mild to moderate COPD, most deaths are due to cardiovascular disease and lung cancer, but as COPD severity increases, respiratory deaths are increasingly common.

How long do you live with Stage 4 COPD? ›

Stage 2: 2.2 years. Stage 3: 5.8 years. Stage 4: 5.8 years.

What stage of COPD do you need oxygen? ›

Supplemental oxygen is typically needed if you have end-stage COPD (stage 4). The use of any of these treatments is likely to increase significantly from stage 1 (mild COPD) to stage 4.

How is the dyspnea scored? ›

The CR 10 [36] is a categorical scale with a score from 0 to 10, where 0 (as a measure of dyspnea) corresponds to the sensation of normal breathing (absence of dyspnea) and 10 corresponds to the subject's maximum possible sensation of dyspnea.

What is the meaning of Dyspneic? ›

: difficult or labored respiration.

What does MVV measure? ›

The maximal voluntary ventilation (MVV) is the largest amount of air that a person can inhale and then exhale during a 12- to 15-s interval with maximal voluntary effort (Neder et al., 1999).

What functional tests and types of questionnaires might you administer for a COPD patient? ›

In terms of COPD, COSMIN has been used to assess COPD assessment test (CAT) questionnaire, health-related quality of life (HRQOL) questionnaires, and arm exercise capacity.

What is the best exercise for someone with COPD? ›

The best types of physical exercise for COPD are stretching, aerobic exercise, and resistance training. The best breathing exercises include pursed lip breathing and diaphragmatic breathing. Tai chi and yoga, which combine physical activity and breathing work, are often also beneficial.

Does exercise improve lung function test in COPD? ›

In general regular exercise does not substantially change measures of pulmonary function such as total lung capacity, the volume of air in the lungs after taking the largest breath possible (TLC), and forced vital capacity, the amount of air able to be blown out after taking the largest breath possible (FVC).

Videos

1. Session 1: COPD Case Webinar Series
(Lung Health Foundation)
2. Evidence-based eHealth for COPD
(ERSeducation)
3. Chronic Pulmonary Pathophysiology 3: COPD Impairments and Limitations
(PTReviewer)
4. Chronic obstructive pulmonary disease (COPD)
(MedLecturesMadeEasy)
5. Volkskrankheit COPD: Ist eine Prävention möglich? Wie schütze ich mich vor dem Raucherhusten?
(DoktorWeigl)
6. COPD - A Clinical Overview for Medical Students
(The Medics Guide)

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