Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in adults. Although FEV(1) remains the most important physiologic indicator of the severity of airflow obstruction in COPD, its predictive value for mortality is weak when it is higher than 50% of predicted. Furthermore, other easily obtainable clinical variables predict mortality better than the FEV(1) in COPD patients with a wide range of airflow limitation. Chief among these predictors are functional dyspnea, exercise capacity, and the body mass index (BMI), although emerging research suggests a potential role for biomarker profiles in outcome predictions. The validated multidimensional BMI (B), degree of airflow obstruction as expressed by the FEV(1) (O), dyspnea with the modified medical research council (D), and exercise (E) measured with the 6min walk or BODE index encompasses the predictive validity of the best of these variables into a single surrogate measure of disease severity and survival. This article reviews these predictors of mortality in COPD.
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