Using the DOSE index to predict changes in health status of patients with COPD: a prospective cohort study

Myrte Rolink, Wouter van Dijk, Saskia van den Haak-Rongen, Willem Pieters, Tjard Schermer, Lisette van den Bemt, Myrte Rolink, Wouter van Dijk, Saskia van den Haak-Rongen, Willem Pieters, Tjard Schermer, Lisette van den Bemt

Abstract

Background: The severity of chronic obstructive pulmonary disease (COPD) should not be based on the level of airflow limitation alone. A multicomponent index such as the DOSE index (dyspnoea score (D), level of airflow obstruction (O), current smoking status (S), and exacerbations (E)) has the potential to predict important future outcomes in patients with COPD more effectively than the forced expiratory volume in one second. Health status deterioration should be prevented in COPD patients.

Aims: To investigate whether the DOSE index can predict which patients are at risk of a clinically relevant change in health status.

Methods: A prospective cohort study was performed using data from primary and secondary care. The DOSE score was determined at baseline and the 2-year change in the Clinical COPD Questionnaire (CCQ) score was calculated. Linear regression analysis was performed for the effect of a high DOSE score (≥ 4) on the change in CCQ score.

Results: The study population consisted of 209 patients (112 patients from primary care). Overall, a high DOSE score was a significant predictor of a change in CCQ score after 2 years (0.41, 95% CI 0.13 to 0.70), particularly in primary care patients.

Conclusions: A DOSE score of ≥ 4 has the ability to identify COPD patients with a greater risk of future worsening in health status.

Conflict of interest statement

The authors declare that they have no conflicts of interest in relation to this article.

Figures

Figure 1. Flow chart of patient selection
Figure 1. Flow chart of patient selection
Figure 2. Distribution of DOSE scores for…
Figure 2. Distribution of DOSE scores for COPD study population from primary and secondary care

References

    1. World Health Organization. COPD factsheet. 2008. Available from: (accessed 2 May 2012).
    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2011 (updated December 2011). Available from: (accessed 2 May 2012).
    1. Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J 1977;1:1645–8.
    1. Celli BR, Cote CG, Lareau SC, Meek PM. Predictors of survival in COPD: more than just the FEV1. Respir Med 2008;102:S27–S35.
    1. Oga T, Tsukino M, Hajiro T, Ikeda A, Nishimura K. Predictive properties of different multidimensional staging systems in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2011;6:521–6.
    1. van der Molen T. Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences. Prim Care Respir J 2010;19:326–34.
    1. Wouters EF. Chronic obstructive pulmonary disease. 5: Systemic effects of COPD. Thorax 2002;57:1067–70.
    1. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J 2006;28:1245–57.
    1. Tsiligianni I, Kocks J, Tzanakis N, Siafakas N, van der Molen T. Factors that influence disease-specific quality of life or health status in patients with COPD: a review and meta-analysis of Pearson correlations. Prim Care Respir J 2011;20:257–68.
    1. Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet 2012;379:1341–51.
    1. Dijk WD, Bemt L, Haak-Rongen S, et al. Multidimensional prognostic indices for use in COPD patient care. A systematic review. Respir Res 2011;12:151.
    1. Jones RC, Donaldson GC, Chavannes NH, et al. Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease: the DOSE Index. Am J Respir Crit Care Med 2009;180:1189–95.
    1. Sundh J, Janson C, Lisspers K, Stallberg B, Montgomery S. The Dyspnoea, Obstruction, Smoking, Exacerbation (DOSE) index is predictive of mortality in COPD. Prim Care Respir J 2012;21(3):295–301.
    1. 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;54:581–6.
    1. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 1993;16:5–40.
    1. National Institute for Clinical Excellence. Chronic obstructive pulmonary disease: national clinical guideline for management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004;59(Suppl I):i1–232.
    1. van der Molen T, Willemse B, Schokker S, ten Hacken N, Postma D, Juniper E. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Quality of Life Outcomes 2003;1:13.
    1. Kocks JW, Tuinenga MG, Uil SM, van den Berg JW, Stahl E, van der Molen T. Health status measurement in COPD: the minimal clinically important difference of the clinical COPD questionnaire. Respir Res 2006;7:62.
    1. Centraal Bureau voor de Statistiek [Internet]. Standaard Beroepenclassificatie 1992 (SBC-92) [Standard Profession Classification]. 1992 (updated 2001). Available from: (accessed 15 May 2012).
    1. Geijer RMM, Chavannes NH, Muris JWM, I. NHG standaard Astma bij volwassenen. [Dutch College of General Practitioners guideline on adult asthma]. Huisarts Wet 2007;50:537–51.
    1. Mannino DM, Diaz-Guzman E, Buist S. Pre- and post-bronchodilator lung function as predictors of mortality in the Lung Health Study. Respir Res 2011;12:136.
    1. Quint JK, Donaldson GC, Hurst JR, Goldring JJ, Seemungal TR, Wedzicha JA. Predictive accuracy of patient reported exacerbation frequency in chronic obstructive pulmonary disease. Eur Respir J 2011;37(3):501–07.
    1. Smeele IJM, van Weel C, van Schayck CP, et al. NHG-Standaard COPD tweede herziening. [Dutch College of General Practitioners guideline on COPD, second revision]. Huisarts Wet 2007;50:362–79.
    1. Chavannes NH, Grijsen M, van den AM, et al. Integrated disease management improves one-year quality of life in primary care COPD patients: a controlled clinical trial. Prim Care Respir J 2009;18:171–6.
    1. Gruffydd-Jones K, Richman J, Jones RC, Wang X. A pilot study of identification and case management of high-risk COPD patients in a general practice. Family Pract 2010;27(5):494–8.

Source: PubMed

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