Correlation of Bode Index with the Presence or Absence of Pulmonary Hypertension to Predict further Admissions among Patients with COPD

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD), is a devastating lung disease which leads to progressive difficulty in breathing. COPD prevalence and mortality are continuing to increase despite adequate measures due to continued exposure to risk factors especially smoking among women and adolescents. GOLD estimates suggest that COPD will rise from sixth to third most common cause of death by 2020. The cost on health resources is immense. COPD (Chronic Obstructive Pulmonary Disease) is an umbrella term used to describe lung disease associated with airflow obstruction which is not reversible. Mostly, emphysema and chronic bronchitis, either alone or combined, come in this category. There is a debate whether this term also includes asthma. However, as a general rule, it is not included. Although it does have obstructive components, it is reversible and is considered a restrictive lung disease. Many patients with COPD also have an asthmatic component to their illness as well. Usually the severity of COPD is graded based on only Forced Expiratory Volume (FEV1). As COPD is a multisystem disorder FEV1 alone cannot determine the outcome in these patients. Hence a multidimensional grading system was designed which included four variables body-mass index (B), the degree of airflow obstruction (O) and dyspnea (D), and exercise capacity (E) measured by the six-minute–walk test. AIMS AND OBJECTIVES: 1. To correlate severity of BODE index to severity of Pulmonary Hypertension. 2. To predict future respiratory admissions based on the disease severity as assesed by BODE index and Pulmonary Hypertension. 3. By initiating appropiate and adequate therapy along with cardiopulmonary rehabilitation measures whether the severity of BODE index can be downsized. MATERIALS AND METHODS: Study Design: Place: Govt. Stanley Hospital. Study Design: Observational Study. Period of study : April 2011 to June 2011. Sample Size: 100 Cases. Inclusion Criteria: A FEV1 of less than 15% from the baseline value measured 2o minutes after the administration of salbutamol with significant symptoms. Exclusion Criteria: • Comorbid conditions previously detected CCF or UA, Myocardial infarction within the preceeding 4 months. • An inability to take the lung function test and six minute walk tests. • Asthma defined as an increase in FEV1 of more than 15% above the baseline value or of 200ml after administration of bronchodialator. • Patients with TB, Bronchiectasis or any other parenchymal lung disease. METHODOLOGY: All the patients who attend medicine OPD and chest clinic OPD will be screened according to the inclusion exclusion criteria and those patients who satisfy the criteria and give consent will be enrolled. For each subject- smoking, personal , occupational histories were obtained. Height and weight were also measured during the examination. Weight was measured by a weighing machine. Height was measured in “mm” with the stadometer. Body mass index (BMI) was calculated using the formula. BMI = Weight in Kgs / (Height in Ms)2. After clinical examination they will be subjected to PFT using a spirometer. Spirometry is performed using a portable spirometer (SpiroPro; Erich Jaeger GmbH; Hoechberg, Germany) according to the American Thoracic society. STATISTICAL ANALYSIS: After catergorizing the variables statistical analysis was done in 100 patients. Baseline data was collected from patients without and with mild, moderate and severe COPD. Ages, FEV1, number of admissions, pulmonary hypertension, of all subjects were the parameters analyzed. The significance of difference in means between two groups was analyzed using the one way ANOVA F-test and the significance of difference in proportions by the Chi square test. Statistical significance was taken when the p-value was less than 0.05. SUMMARY: In our study comprising hundred patients of COPD , conducted in government Stanley medical college ,we had compared BODE score with various parameters and analysed it statistically and got the following results ; Summarising. • BODE score was much better in predicting the morbidity and mortality associated with COPD than FEV1; • Males were predominantly affected by COPD in our study ; this was in concordance with other similar studies ; • The prevalence of COPD increased with age in our study and the association was statistically significant ; • Maximum number of COPD patients occurred in the age group 50 – 60 years in our study ; • BODE score correlated with the severity of COPD and PHT and this correlation was statistically significant in our study. • Higher the BODE score, frequent the number of readmissions. • BODE score is amenable to modification with appropriate medical intervention and thus can be used to assess therapeutic efficiency. CONCLUSIONS: 1. BODE score correlates with severity of pulmonary hypertension and COPD. 2. BODE score can predict the number of readmissions in COPD Patients. 3. BODE score can be improved by adequate and timely therapeutic intervention and rehabilitative measures