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Am J Respir Crit Care Med. 2009 Dec 15;180(12):1189-95. doi: 10.1164/rccm.200902-0271OC. Epub 2009 Sep 24.

Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease: the DOSE Index.

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1
Respiratory Research Unit, Peninsula Medical School, University of Plymouth, Devon, UK. rupert.jones@pms.ac.uk

Abstract

RATIONALE:

Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a multicomponent disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD.

OBJECTIVES:

To derive and validate a multicomponent assessment tool of COPD severity that is applicable to all patients and health care settings.

METHODS:

The index was derived using data from 375 patients with COPD in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD Questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S), and exacerbation frequency (E). The DOSE Index was validated in cross-sectional and longitudinal samples in various health care settings in Holland, Japan, and the United Kingdom.

MEASUREMENTS AND MAIN RESULTS:

The DOSE Index correlated with health status in all data sets. A high DOSE Index score (> or = 4) was associated with a greater risk of hospital admission (odds ratio, 8.3 [4.1-17]) or respiratory failure (odds ratio, 7.8 [3.4-18.3]). The index predicted exacerbations in the subsequent year (P < or = 0.014).

CONCLUSIONS:

The DOSE Index is a simple, valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as health care consumption and predicts future events.

Comment in

PMID:
19797160
DOI:
10.1164/rccm.200902-0271OC
[Indexed for MEDLINE]
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