Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease

the DOSE Index

Rupert C Jones, Gavin C Donaldson, Niels H Chavannes, Kozui Kida, Maria Dickson-Spillmann, Samantha Harding, Jadwiga A Wedzicha, David Price, Michael E Hyland

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

RATIONALE: Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a multicomponent disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD. OBJECTIVES: To derive and validate a multicomponent assessment tool of COPD severity that is applicable to all patients and health care settings. METHODS: The index was derived using data from 375 patients with COPD in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD Questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S), and exacerbation frequency (E). The DOSE Index was validated in cross-sectional and longitudinal samples in various health care settings in Holland, Japan, and the United Kingdom. MEASUREMENTS AND MAIN RESULTS: The DOSE Index correlated with health status in all data sets. A high DOSE Index score (> or = 4) was associated with a greater risk of hospital admission (odds ratio, 8.3 [4.1-17]) or respiratory failure (odds ratio, 7.8 [3.4-18.3]). The index predicted exacerbations in the subsequent year (P <or = 0.014). CONCLUSIONS: The DOSE Index is a simple, valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as health care consumption and predicts future events.
Original languageEnglish
Pages (from-to)1189-1195
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume180
Issue number12
Early online date24 Sep 2009
DOIs
Publication statusPublished - 15 Nov 2009

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Chronic Obstructive Pulmonary Disease
Delivery of Health Care
Health Status
Odds Ratio
Respiratory Insufficiency
Netherlands
Dyspnea
Primary Health Care
Patient Care
Japan
Smoking
Regression Analysis
Quality of Life
Lung

Keywords

  • aged
  • cohort studies
  • cross-sectional studies
  • dyspnea
  • female
  • health status
  • hospitalization
  • humans
  • longitudinal studies
  • male
  • middle aged
  • odds ratio
  • pulmonary disease, chronic obstructive
  • questionnaires
  • reproducibility of results
  • respiratory insufficiency
  • severity of illness index
  • smoking

Cite this

Jones, R. C., Donaldson, G. C., Chavannes, N. H., Kida, K., Dickson-Spillmann, M., Harding, S., ... Hyland, M. E. (2009). Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease: the DOSE Index. American Journal of Respiratory and Critical Care Medicine, 180(12), 1189-1195. https://doi.org/10.1164/rccm.200902-0271OC

Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease : the DOSE Index. / Jones, Rupert C; Donaldson, Gavin C; Chavannes, Niels H; Kida, Kozui; Dickson-Spillmann, Maria; Harding, Samantha; Wedzicha, Jadwiga A; Price, David; Hyland, Michael E.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 180, No. 12, 15.11.2009, p. 1189-1195.

Research output: Contribution to journalArticle

Jones, RC, Donaldson, GC, Chavannes, NH, Kida, K, Dickson-Spillmann, M, Harding, S, Wedzicha, JA, Price, D & Hyland, ME 2009, 'Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease: the DOSE Index', American Journal of Respiratory and Critical Care Medicine, vol. 180, no. 12, pp. 1189-1195. https://doi.org/10.1164/rccm.200902-0271OC
Jones, Rupert C ; Donaldson, Gavin C ; Chavannes, Niels H ; Kida, Kozui ; Dickson-Spillmann, Maria ; Harding, Samantha ; Wedzicha, Jadwiga A ; Price, David ; Hyland, Michael E. / Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease : the DOSE Index. In: American Journal of Respiratory and Critical Care Medicine. 2009 ; Vol. 180, No. 12. pp. 1189-1195.
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abstract = "RATIONALE: Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a multicomponent disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD. OBJECTIVES: To derive and validate a multicomponent assessment tool of COPD severity that is applicable to all patients and health care settings. METHODS: The index was derived using data from 375 patients with COPD in primary care. Regression analysis led to a model explaining 48{\%} of the variance in health status as measured by the Clinical COPD Questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S), and exacerbation frequency (E). The DOSE Index was validated in cross-sectional and longitudinal samples in various health care settings in Holland, Japan, and the United Kingdom. MEASUREMENTS AND MAIN RESULTS: The DOSE Index correlated with health status in all data sets. A high DOSE Index score (> or = 4) was associated with a greater risk of hospital admission (odds ratio, 8.3 [4.1-17]) or respiratory failure (odds ratio, 7.8 [3.4-18.3]). The index predicted exacerbations in the subsequent year (P <or = 0.014). CONCLUSIONS: The DOSE Index is a simple, valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as health care consumption and predicts future events.",
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AU - Chavannes, Niels H

AU - Kida, Kozui

AU - Dickson-Spillmann, Maria

AU - Harding, Samantha

AU - Wedzicha, Jadwiga A

AU - Price, David

AU - Hyland, Michael E

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N2 - RATIONALE: Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a multicomponent disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD. OBJECTIVES: To derive and validate a multicomponent assessment tool of COPD severity that is applicable to all patients and health care settings. METHODS: The index was derived using data from 375 patients with COPD in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD Questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S), and exacerbation frequency (E). The DOSE Index was validated in cross-sectional and longitudinal samples in various health care settings in Holland, Japan, and the United Kingdom. MEASUREMENTS AND MAIN RESULTS: The DOSE Index correlated with health status in all data sets. A high DOSE Index score (> or = 4) was associated with a greater risk of hospital admission (odds ratio, 8.3 [4.1-17]) or respiratory failure (odds ratio, 7.8 [3.4-18.3]). The index predicted exacerbations in the subsequent year (P <or = 0.014). CONCLUSIONS: The DOSE Index is a simple, valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as health care consumption and predicts future events.

AB - RATIONALE: Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a multicomponent disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD. OBJECTIVES: To derive and validate a multicomponent assessment tool of COPD severity that is applicable to all patients and health care settings. METHODS: The index was derived using data from 375 patients with COPD in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD Questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S), and exacerbation frequency (E). The DOSE Index was validated in cross-sectional and longitudinal samples in various health care settings in Holland, Japan, and the United Kingdom. MEASUREMENTS AND MAIN RESULTS: The DOSE Index correlated with health status in all data sets. A high DOSE Index score (> or = 4) was associated with a greater risk of hospital admission (odds ratio, 8.3 [4.1-17]) or respiratory failure (odds ratio, 7.8 [3.4-18.3]). The index predicted exacerbations in the subsequent year (P <or = 0.014). CONCLUSIONS: The DOSE Index is a simple, valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as health care consumption and predicts future events.

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KW - middle aged

KW - odds ratio

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KW - questionnaires

KW - reproducibility of results

KW - respiratory insufficiency

KW - severity of illness index

KW - smoking

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JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

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