Case history: A 66-year-old woman with COPD attends for review. She has an FEV1 of 48% predicted, a BMI of 21 kg·m-2, frequent exacerbations, exertional breathlessness when walking 100 m on the level and comorbid osteoporosis. What is the best way to predict her future mortality risk? How can multidimensional indices inform prognosis? What are the strengths and weaknesses of the available tools?
Chapter summary: Because the hallmark of COPD is the presence of airflow limitation, its severity and progression have been defined using the degree of airflow limitation. Research has shown that extrapulmonary manifestations of COPD are important and that they relate to poor outcomes. COPD is now considered to be a disease with systemic manifestations; it is therefore clear that there is a need to quantify and to incorporate the consequences of those manifestations to better reflect the actual compromise of patients. To grade disease severity, the index must not only relate to all-cause mortality, it should also reflect specific organ involvement or failure. This chapter provides a summary of the strengths and weaknesses of most of the indices available. Perhaps the time has come not to develop new ones but rather to test their practical impact on the management of patients in the clinical arena.