Pulmonary rehabilitation

In their Clinical Therapeutics article, Casaburi and ZuWallack (March 26 issue) do not discuss the BODE index and its role in evaluating the effect of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD).

The BODE index incorporates the body-mass index (BMI), the severity of airflow obstruction and dyspnea, and exercise tolerance in a 10-point scale in which higher scores indicate a higher risk of death. This index has been shown to be a better predictor of mortality than Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging, which classifies only the severity of obstruction.

Changes in the BODE index correlate with favorable outcomes after surgery for lung-volume reduction and after pulmonary rehabilitation. In a controlled study, patients with COPD undergoing pulmonary rehabilitation had improved BODE scores and outcomes.

The authors found that mortality due to respiratory disease at 2 years after pulmonary rehabilitation was 7%, as compared with 39% in the control group. Furthermore, their analysis showed that BODE scores returned to baseline after 2 years of follow-up, confirming what most of us already know about pulmonary rehabilitation: its benefits wane over time

CITATION  N Engl J Med. 2009 Jun 18;360(25):2678; author reply 2678-9