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 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

The Clinical Frailty Scale is a tool used to classify an individual's level of frailty based on a selection that describes their fitness or frailty. This classification helps in assessing the individual's physical and cognitive abilities as well as their degree of independence in daily life activities. Here’s how it works:

- The scale provides a list of descriptions, each capturing a different level of fitness or frailty. The individual selects the description that best matches their current condition.
- Each description corresponds to a specific level of frailty, ranging from "very fit" to "terminally ill."

Here's a breakdown of the descriptions and their corresponding frailty levels:

1. Individuals who are robust, active, energetic, and motivated, regularly engaging in exercise, are categorized as "Very fit."
2. Those without active disease symptoms, but who exercise or are active occasionally, are considered "Well."
3. People with well-controlled symptoms, who are active only through routine walking, fall under "Managing well."
4. If symptoms limit activity, leading to complaints of feeling "slowed up" or tired during the day, they are labeled as "Vulnerable."
5. When there is more evident slowing and help is needed in high-order instrumental activities such as managing finances and transportation, the label is "Mildly frail."
6. Needing help with outside activities and house maintenance, requiring assistance with stairs and bathing, indicates "Moderately frail."
7. Complete dependence on personal care, yet stable and not at high risk of imminent death, describes the "Severely frail."
8. Complete dependence and inability to recover even from minor illnesses suggest "Very severely frail."
9. Approaching the end of life with a life expectancy of fewer than six months, with no apparent frailty, indicates "Terminally ill."

Using this scale, the user’s selection directly translates to a specific level of frailty, which can aid healthcare professionals in evaluating and planning the appropriate care strategy.

The Clinical Frailty Scale (CFS) is a tool used to assess the level of frailty in older adults, typically those aged 65 and above. The scale is designed to provide a measure of the patient's vulnerability to adverse outcomes, including disability, hospitalization, and mortality. The CFS is particularly useful in geriatric medicine, where it can help guide treatment decisions and care planning. It is based on patient's physical activity, energy, physical ability, and health changes. The scale ranges from 1 (very fit) to 9 (terminally ill). The CFS may not be appropriate for use in younger populations or in individuals with primarily cognitive impairment, as it does not specifically assess cognitive function.

Clinical Frailty Scale

Dyspnea in palliative care

Benzodiazepines

Supplemental oxygen

General principles

Airflow interventions

Corticosteroids

Management of underlying conditions

Alternative and complementary therapies

Clinical assessment

Opioids

Noninvasive ventilation

Walking aids

Neuromuscular electrical stimulation

Sedation

Bronchodilators

Nutritional support

Breathing techniques

Therapies with no evidence for benefit

Antidepressants

Exercise

Updated 2024 ERS guidelines for symptomatic management in serious respiratory diseases


Dyspnea in palliative care

Guidelines

Key sources