Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The BODE index for survival of COPD is a tool used to gauge the severity of chronic obstructive pulmonary disease by examining four health parameters: FEV₁ percentage of predicted, distance covered in a 6-minute walk, the MMRC Dyspnea Scale, and Body Mass Index (BMI). Each parameter is assigned a score based on predefined categories.

1. **FEV₁ (% of predicted):**
   - >= 65%: 0 points
   - 50-64%: 1 point
   - 36-49%: 2 points
   - <= 35%: 3 points

2. **Distance walked in a 6-minute walk:**
   - >= 350 meters: 0 points
   - 250-349 meters: 1 point
   - 150-249 meters: 2 points
   - <= 149 meters: 3 points

3. **MMRC Dyspnea Scale:**
   - Dyspnea only with strenuous exercise: 0 points
   - Dyspnea when hurrying or walking up a slight hill: 0 points
   - Walks slower than people of the same age due to dyspnea or stops for breath when walking at own pace: 1 point
   - Short of breath after walking a few minutes or 100 yards (91 m): 2 points
   - Too breathless to leave home or breathless when dressing: 3 points

4. **Body Mass Index (BMI):**
   - > 21: 0 points
   - <= 21: 1 point

The scores from these categories are summed to produce a total BODE index score, ranging from 0 to 10. This score provides valuable insights into a patient’s 4-year survival probability, helping healthcare providers make informed decisions about care and management. The interpretation of the score is as follows:

- Scores between 0 to 2 suggest an 80% probability of surviving four years.
- Scores from 3 to 4 indicate a 67% chance of 4-year survival.
- A score between 5 to 6 reflects a 57% survival likelihood.
- Scores from 7 to 10 predict a lower 4-year survival rate of 18%.

This systematic approach allows for stratification of patients by risk level, aiding in tailored treatment planning and counseling based on COPD severity.

The BODE Index, or the Body-Mass Index, Obstruction of Airflow, Dyspnea, and Exercise Capacity Index, is a scoring system used for patients with Chronic Obstructive Pulmonary Disease (COPD). This calculator is designed to predict the survival rate of patients with COPD, and it is used to stratify the severity of the disease and guide treatment decisions. 

The BODE Index takes into account four factors: the Body-Mass Index (BMI), the degree of airflow Obstruction measured by Forced Expiratory Volume in one second (FEV1), the level of Dyspnea assessed by the Modified Medical Research Council (MMRC) Dyspnea Scale, and Exercise capacity measured by the distance covered in a 6-minute walk test. 

The BODE Index is applicable to patients diagnosed with COPD. It is not suitable for patients with other types of respiratory diseases or conditions that might affect the parameters measured, such as severe cardiac disease, musculoskeletal disorders, or neurological conditions that could impact the 6-minute walk test. It is also not appropriate for use in patients who have not been definitively diagnosed with COPD.

BODE index for survival of COPD

The DECAF score categorizes COPD exacerbations by evaluating five clinical criteria to predict the risk of in-hospital mortality. Each criterion contributes a specific point value to the total score. 

The criteria and their corresponding scores are as follows:

- eMRCD Dyspnea Level:
  - eMRCD 1-4: 0 points
  - eMRCD 5a (too dyspneic to leave the house, but independent with washing/dressing): 1 point
  - eMRCD 5b (too dyspneic to leave the house, requires washing/dressing): 2 points

- Eosinopenia:
  - Yes (eosinophil count < 0.05×10⁹/L): 1 point
  - No: 0 points

- Consolidation on Chest X-ray:
  - Yes: 1 point
  - No: 0 points

- Moderate to Severe Acidemia:
  - Yes (pH < 7.3): 1 point
  - No: 0 points

- Atrial Fibrillation (past or present):
  - Yes: 1 point
  - No: 0 points

Each response is transformed into a score using the categories above. The overall DECAF score is the sum of these points, ranging from 0 to 6. Based on this score, the calculated risk of in-hospital mortality is interpreted as follows:

- A score of 0 corresponds to a low-risk group with 0% in-hospital mortality.
- A score of 1 still characterizes a low-risk group, showing a 1.5% mortality risk.
- A score of 2 indicates an intermediate risk with a 5.4% chance of mortality.
- A score of 3 identifies a high-risk group, raising the mortality risk to 15.3%.
- A score of 4 places the patient firmly in the high-risk category with a 31% mortality chance.
- A score of 5 increases the risk within this group to 40.5%.
- Finally, a score of 6 represents the highest risk group with a 50% chance of mortality.

This scoring system aids healthcare professionals in assessing COPD severity, guiding management decisions effectively in clinical settings.

The DECAF Score is a clinical calculator used for patients with Chronic Obstructive Pulmonary Disease (COPD). DECAF stands for Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation. This scoring system is used to predict the in-hospital mortality risk of patients admitted with acute exacerbations of COPD. 

The DECAF score is applicable to patients with a confirmed diagnosis of COPD who are experiencing an acute exacerbation severe enough to warrant hospital admission. It is not suitable for use in patients without a COPD diagnosis, those with stable COPD, or those with other primary causes of respiratory distress. The score helps clinicians to make informed decisions about the level of care required, including the need for intensive care admission.

DECAF score for COPD

The COPD Assessment Test (CAT) is designed to measure the impact of chronic obstructive pulmonary disease on a person's daily life. It involves responding to eight items about symptoms and limitations. For each question, the participant selects an answer from a predefined scale, which is converted to a numerical score.

The scoring system assigns values as follows:

- Cough: 
  - "I never cough" = 0
  - "1" = 1
  - "2" = 2
  - "3" = 3
  - "4" = 4
  - "I cough all the time" = 5
- Phlegm:
  - "I have no phlegm in my chest at all" = 0
  - "1" = 1
  - "2" = 2
  - "3" = 3
  - "4" = 4
  - "My chest is completely full of phlegm" = 5
- Chest tightness:
  - "My chest does not feel tight at all" = 0
  - "1" = 1
  - "2" = 2
  - "3" = 3
  - "4" = 4
  - "My chest feels very tight" = 5
- Breathlessness:
  - "When I walk up a hill or one flight of stairs I am not breathless" = 0
  - "1" = 1
  - "2" = 2
  - "3" = 3
  - "4" = 4
  - "When I walk up a hill or one flight of stairs I am very breathless" = 5
- Activities:
  - "I am not limited doing any activities at home" = 0
  - "1" = 1
  - "2" = 2
  - "3" = 3
  - "4" = 4
  - "I am very limited doing any activities at home" = 5
- Confidence:
  - "I am confident leaving my home despite my lung condition" = 0
  - "1" = 1
  - "2" = 2
  - "3" = 3
  - "4" = 4
  - "I am not at all confident leaving my home because of my lung condition" = 5
- Sleep:
  - "I sleep soundly" = 0
  - "1" = 1
  - "2" = 2
  - "3" = 3
  - "4" = 4
  - "I don't sleep soundly because of my lung condition" = 5
- Energy:
  - "I have lots of energy" = 0
  - "1" = 1
  - "2" = 2
  - "3" = 3
  - "4" = 4
  - "I have no energy at all" = 5

To calculate the total score, simply add the numerical values for each response. This score can range from 0 to 40.

The interpretation of the score reflects the health impact of COPD:
- A score from 0 to 10 suggests a "Low health impact."
- A score from 11 to 20 suggests a "Medium health impact."
- A score from 21 to 30 suggests a "High health impact."
- A score from 31 to 40 suggests a "Very high health impact."

This provides a straightforward way to assess how COPD affects an individual's life across different areas, making it easier to identify where additional management might be needed.

The COPD Assessment Test (CAT) is a clinical calculator used specifically for patients with Chronic Obstructive Pulmonary Disease (COPD). This scoring system is designed to measure the impact of COPD on a person's life, and how this changes over time. It is a patient-completed instrument that helps to quantify the impact of COPD symptoms on health status. The CAT score is used to guide treatment decisions, assess disease progression, and evaluate the effectiveness of treatments in COPD patients. It is not suitable for use in patients without a confirmed diagnosis of COPD or in those with other respiratory disorders as it is specifically designed for COPD.

COPD Assessment Test (CAT)

The BAP-65 score calculator helps estimate the risk of in-hospital mortality for patients experiencing an acute exacerbation of COPD by evaluating four key clinical parameters: blood urea nitrogen (BUN) levels, mental status, pulse rate, and age.

Inputs you need to consider:
- BUN level, assessed as either: 
  - Yes: BUN ≥ 25 mg/dL (8.9 mmol/L)
  - No
- Mental status, categorized as:
  - Yes: Altered 
  - No
- Pulse rate, indicated as either:
  - Yes: Pulse ≥ 109 beats per minute
  - No
- Age, grouped as:
  - 41-64 years
  - ≥ 65 years

The calculation involves each parameter contributing to an overall risk class from I to V, with increasing class numbers indicating higher risk of mortality.

Steps and interpretation possibilities:
- Class I: If BUN is normal, mental status is normal, pulse is normal, and age is between 41-64 years, the risk of in-hospital mortality is 0.5%.
- Class II: If BUN is normal, mental status is normal, pulse is normal, and age is ≥ 65 years, the risk is 1.4%.
- Class III: For patients of any age with one of the following—high BUN, altered mental status, or high pulse—the risk rises to 3.7%.
- Class IV: For patients of any age displaying two of the following—high BUN, altered mental status, or high pulse—the risk increases significantly to 12.7%.
- Class V: For patients of any age with high BUN, altered mental status, and high pulse, the risk peaks at 26.2%.

This structured approach enables healthcare professionals to assess and stratify the mortality risk associated with acute exacerbation of COPD effectively, guiding treatment decisions and patient management strategies.

The BAP-65 score is a clinical calculator used for patients with acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD). The name BAP-65 stands for Blood Urea Nitrogen (BUN), Altered Mental Status, Pulse, and age 65. This scoring system is used to predict in-hospital mortality and the need for mechanical ventilation in patients with COPD exacerbations. 

The BAP-65 score is calculated based on four criteria: BUN > 25 mg/dL, altered mental status, pulse ≥ 109 beats per minute, and age ≥ 65 years. Each criterion is assigned one point, and the total score ranges from 0 to 4. Higher scores indicate a higher risk of in-hospital mortality and the need for mechanical ventilation.

The BAP-65 score is applicable to patients with acute exacerbations of COPD. It is not suitable for use in patients without COPD, or in those with other primary causes of respiratory failure. It should also not be used in isolation to make clinical decisions, but rather as a tool to aid in risk stratification and decision-making.

BAP-65 score for acute exacerbation of COPD

The Modified Medical Research Council (mMRC) dyspnea scale is used to evaluate the level of breathlessness an individual experiences in everyday life. The tool involves selecting the statement that best describes one's experience with dyspnea. Based on this selection, the mMRC dyspnea scale assigns a numerical score that indicates the severity, with higher scores corresponding to more significant breathlessness.

Here's how the process works:

- You are provided with a list of scenarios reflecting different levels of breathlessness.
- Choose the statement that most accurately represents your current condition:
  - Dyspnea only with strenuous exercise
  - Dyspnea when hurrying or walking up a slight hill
  - Walks slower than people of the same age due to dyspnea or needs to stop for breath when walking at own pace
  - Stops for breath after walking 100 yards (91 m) or after a few minutes
  - Too dyspneic to leave the house or dyspneic when dressing or undressing
  
Each option correlates to a specific score:

| Description                                                            | Score |
|-----------------------------------------------------------------------|-------|
| Dyspnea only with strenuous exercise                                  | 0     |
| Dyspnea when hurrying or walking up a slight hill                      | 1     |
| Walks slower than peers due to dyspnea or needs frequent stops        | 2     |
| Stops for breath after brief exertion                                  | 3     |
| Too dyspneic to leave the house or when dressing/undressing           | 4     |

Upon selecting the most suitable statement, you are assigned a score that provides a measure of breathlessness severity. The interpretation of this score is straightforward:

- Score of 0 suggests minimal dyspnea; this is Grade 0.
- Score of 1 indicates mild dyspnea when engaged in moderate activity; this is Grade 1.
- Score of 2 reflects moderate dyspnea affecting pace and ability compared to peers; this is Grade 2.
- Score of 3 shows severe dyspnea causing frequent pauses in activity; this is Grade 3.
- Score of 4 denotes very severe dyspnea, restricting everyday activities significantly; this is Grade 4.

Each grade is a clear indicator of the level of breathlessness experienced and aids in assessing the need for further medical evaluation or treatment adjustments.

The Modified Medical Research Council (mMRC) Dyspnea Scale is a clinical calculator used to assess the level of breathlessness in patients with respiratory diseases, particularly chronic obstructive pulmonary disease (COPD). The scale ranges from 0 to 4, with 0 indicating no breathlessness except with strenuous exercise and 4 indicating breathlessness while at rest. The mMRC Dyspnea Scale is a simple and effective tool for evaluating the impact of dyspnea on daily activities and quality of life. It is also used to guide treatment decisions and predict health outcomes in patients with COPD. There are no specific exclusion criteria for its use, but it may be less accurate in patients with conditions that cause dyspnea other than COPD.

Modified Medical Research Council (mMRC) dyspnea scale

Chronic obstructive pulmonary disease

Management of acute exacerbations

Management of acute exacerbations, antibiotics

Procalcitonin

Combination therapy

Spirometry

Other pharmacological agents

Palliative care

Palliative care, opioids

Management of acute exacerbations (supplemental oxygen)

Long-term antibiotics

Severity assessment

General principles

General counseling

Management of acute exacerbations, noninvasive ventilation, indications

Management of acute exacerbations (setting of care)

Patients with alpha-1 antitrypsin deficiency

Patients with AAT deficiency

Lung transplantation

Long-acting bronchodilators

Pulmonary rehabilitation

Palliative care, neuromuscular electrical stimulation

Indications for screening

Palliative care (supplemental oxygen)

Mucolytics

Oral corticosteroids

Management of acute exacerbations, corticosteroids

Diagnosis

Phosphodiesterase inhibitors

Short-acting bronchodilators

Management of acute exacerbations (short-acting bronchodilators)

Palliative care (end-of-life care)

Management of acute exacerbations, pulmonary rehabilitation

Routine immunizations

Management of acute exacerbations (noninvasive ventilation, technical considerations)

Palliative care (nutritional support)

Long-term oxygen therapy

Noninvasive ventilation

Smoking cessation

Follow-up

Surgical bullectomy

Management of acute exacerbations (PDE4 inhibitors)

Biologic agents

Bronchoscopic interventions

History and physical examination

Management of acute exacerbations (invasive ventilation)

Inhaled corticosteroids

ICSs

Lung volume reduction surgery

Physical activity

Palliative care, nonpharmacological measures

Palliative care (therapies with no evidence for benefit)

Avoidance of exposures

Updated 2024 GOLD guidelines for the diagnosis and management of chronic obstructive pulmonary disease


Updated 2025 GOLD guidelines for the diagnosis and management of chronic obstructive pulmonary disease


Chronic obstructive pulmonary disease

Background

Overview

Guidelines

Key sources