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26-06-2013 | Respiratory | Article

DOSE excels in predicting COPD exacerbations


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medwireNews: Research shows that the DOSE index outperforms both the BODE and ADO indices in predicting future exacerbations of chronic obstructive pulmonary disease (COPD) in Japanese patients.

The study, published in the International Journal of Chronic Obstructive Pulmonary Disease, included 183 patients who attended monthly assessments between November 2007 and October 2009.

Overall, there were 105 exacerbations in the first year of the study and 88 in the second. In the second year, 64 (35%) patients experienced at least one exacerbation.

Assessment scores for the DOSE (Dyspnea, Obstruction, Smoking, Exacerbations), BODE (Body mass index, Obstruction, Dyspnea, Exercise capacity), and ADO (Age, Dyspnea, Obstruction) indices were all significantly worse in patients who experienced exacerbations than in those who did not, say Takashi Motegi (Nippon Medical School, Tokyo, Japan) and colleagues.

But the DOSE index had significantly greater accuracy for predicting exacerbations, with an area under the receiver operating characteristic curve of 0.75 (where 1.00 is perfect discrimination), compared with 0.66, 0.65, and 0.64 for GOLD stage, BODE index, and ADO index, respectively.

And, in multivariate analysis, the BODE index did not independently predict the occurrence of exacerbations, while the ADO index did, at an odds ratio of 1.40. However, the ADO index did not perform as strongly as the DOSE index, which independently predicted risk at an odds ratio of 2.19.

The authors suggest that the BODE score may be inappropriate for use in Asian populations in whom body mass index differs to Caucasian populations. They say that further research is needed to adjust the index according to ethnicity. The study also adds to findings suggesting that Japanese COPD patients typically experience exacerbations at lower rates than Caucasian patients, which the authors believe may be due to universal insurance coverage.

They propose that DOSE may perform better than the other indices as, by contrast, it incorporates annual exacerbation rates. Additionally, it encourages physicians to collect this information from patients, which is "crucial for providers and patients who must make COPD management decisions for determining optimal treatment."

Motegi and team conclude: "[Previous] results suggest that the DOSE index is a practical tool for assessing current symptoms and future risk in COPD, and we can now confirm that the DOSE index is a stronger predictor than the BODE and ADO indices for predicting the probability of future exacerbations."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter

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