Outcome Evaluation

• Monitor the patient for improvement in symptoms (dyspnea, cough, sputum production, and fatigue).

• Changes in FEV1 should not be the main outcome assessed. FEV1 changes are weakly related to symptoms, exacerbations, and health-related quality of life (outcomes that are important to patients).

• The Medical Research Council dyspnea scale can be used to monitor physical limitation due to breathlessness (Table 15-6). The scale is simple to administer and

correlates well with scores of health status.

• The BODE index is a validated predictor of mortality and a better predictor than

FEV1 alone. It is a composite score derived from body mass index or BMI (B), FEVj or degree of airflow obstruction (O), modified Medical Research Council (MMRC) dyspnea scale (D), and 6-minute walking distance (E, exercise capacity). All of these variables predict important outcomes such as health-related quality of life, the rate of exacerbations, and the risk of death. The composite score is based on a 10-point scale in which higher scores indicate a higher risk of death (Table 15-7). The BODE index can be used clinically to monitor disease progression. Its usefulness in measuring outcomes of drug therapy, pulmonary rehabilitation, and the degree of health care resource utilization needs further study.

• Assess quality of life using the St. George's Respiratory Questionnaire, which has

been validated and is specific for COPD patients.

• Monitor theophylline levels with goal serum concentrations in the range of 5 to 15 mcg/mL (28-83 ^mol/L). Trough levels should be obtained 1 to 2 weeks after ini-

tiation of treatment and after any dosage adjustment. Routine levels are not necessary unless toxicity is suspected or disease has worsened.

Table 15-6 Medical Research Council Dyspnea Scale



Statement About Perceived


Breath lessness*



1 only get breathless with strenuous activity*



"1 get short of breath when hurrying on the level or up a slight hill11



1 walk slower than people of the same age on the level because of breath lessness or 1 have to stop for breath after a mile or soon the level at my own pace*



"1 stop for breath after walking 100 yards or after a few minutes on the lever



1 am too breathless to leave the house or 1 get breathless while dressing*

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