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BODE index: COPD severity and survival

Combine body mass index, airflow obstruction (FEV1), breathlessness (mMRC) and exercise capacity (6-minute walk) into the BODE index, which predicts survival in COPD.

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Results

BODE index

4 / 10

3 to 4 (quartile 2): about 67% survival at 4 years
B, body mass index points
0
O, airflow obstruction points
2
D, dyspnea points
1
E, exercise capacity points
1

This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.

Beyond lung function

Chronic obstructive pulmonary disease (COPD) is usually graded by the FEV1, the volume of air a person can blow out in one second as a percentage of the predicted value. But two people with the same FEV1 can have very different lives: one walks every day, the other is breathless getting dressed and losing weight. In 2004, Bartolomé Celli and colleagues combined four measures into the BODE index, which predicted survival better than FEV1 alone in their cohort of more than 600 patients.

Scoring

Variable 0 points 1 point 2 points 3 points
FEV1, % predicted 65 or more 50 to 64 36 to 49 35 or less
6-minute walk 350 m or more 250 to 349 m 150 to 249 m 149 m or less
mMRC dyspnea grade 0 or 1 2 3 4
Body mass index above 21 21 or less

The total runs from 0 to 10. The distance can be entered in feet: 350 m is about 1,150 ft.

Example

A 68-year-old with COPD has an FEV1 of 45% of predicted, walks 300 m in six minutes, has mMRC grade 2 breathlessness and a BMI of 24:

  • FEV1: 2 points
  • Walk: 1 point
  • Dyspnea: 1 point
  • BMI: 0 points
  • BODE index: 4, second quartile

Survival by quartile

In the original study, approximate four-year survival was:

  • 0 to 2: about 80%
  • 3 to 4: about 67%
  • 5 to 6: about 57%
  • 7 to 10: about 18%

These figures come from patients followed in the late 1990s and early 2000s; treatment has improved since, and an individual’s outlook depends on age, other illnesses and exacerbations.

Why it is useful

Each component can be improved. Pulmonary rehabilitation increases walking distance and reduces breathlessness; nutritional support helps underweight patients; stopping smoking slows the decline of FEV1. The BODE index also helps decide when to discuss lung volume reduction or transplantation, which are typically considered at scores of 7 or more.

Frequently asked questions

What does BODE stand for?

Body mass index, airflow Obstruction (FEV1 as % of predicted), Dyspnea (mMRC scale) and Exercise capacity (6-minute walk distance). Bartolomé Celli and colleagues published it in 2004 in the New England Journal of Medicine.

Why is the BODE index better than FEV1 alone?

COPD affects more than the lungs. Weight loss, breathlessness and poor exercise tolerance each predict death independently of FEV1, and the combined index predicted survival better than FEV1 in the original cohort.

How many points does each item give?

BMI 21 or less gives 1 point. FEV1 gives 0 (65% or more) to 3 (35% or less). The mMRC grade gives 0 for grades 0 and 1, then 1 to 3 for grades 2 to 4. The walk gives 0 (350 m or more) to 3 (149 m or less).

Can the BODE index improve?

Yes. Pulmonary rehabilitation improves breathlessness and walking distance, and stopping smoking, good nutrition and appropriate inhaled treatment help. A drop of one point or more after rehabilitation is linked with better outcomes.

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Results are estimates provided for information purposes. They do not replace professional advice.

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