Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The BODE Index, or the Body-Mass Index, Obstruction of Airflow, Dyspnea, and Exercise Capacity Index, is a scoring system used for patients with Chronic Obstructive Pulmonary Disease (COPD). This calculator is designed to predict the survival rate of patients with COPD, and it is used to stratify the severity of the disease and guide treatment decisions. 

The BODE Index takes into account four factors: the Body-Mass Index (BMI), the degree of airflow Obstruction measured by Forced Expiratory Volume in one second (FEV1), the level of Dyspnea assessed by the Modified Medical Research Council (MMRC) Dyspnea Scale, and Exercise capacity measured by the distance covered in a 6-minute walk test. 

The BODE Index is applicable to patients diagnosed with COPD. It is not suitable for patients with other types of respiratory diseases or conditions that might affect the parameters measured, such as severe cardiac disease, musculoskeletal disorders, or neurological conditions that could impact the 6-minute walk test. It is also not appropriate for use in patients who have not been definitively diagnosed with COPD.

BODE index for survival of COPD

# Description:
The BODE Index, or the Body-Mass Index, Obstruction of Airflow, Dyspnea, and Exercise Capacity Index, is a scoring system used for patients with Chronic Obstructive Pulmonary Disease (COPD). This calculator is designed to predict the survival rate of patients with COPD, and it is used to stratify the severity of the disease and guide treatment decisions. 

The BODE Index takes into account four factors: the Body-Mass Index (BMI), the degree of airflow Obstruction measured by Forced Expiratory Volume in one second (FEV1), the level of Dyspnea assessed by the Modified Medical Research Council (MMRC) Dyspnea Scale, and Exercise capacity measured by the distance covered in a 6-minute walk test. 

The BODE Index is applicable to patients diagnosed with COPD. It is not suitable for patients with other types of respiratory diseases or conditions that might affect the parameters measured, such as severe cardiac disease, musculoskeletal disorders, or neurological conditions that could impact the 6-minute walk test. It is also not appropriate for use in patients who have not been definitively diagnosed with COPD.
---
# Inputs:
## FEV₁ (% of predicted)
A. >= 65% (+0)
B. 50-64% (+1)
C. 36-49% (+2)
D. <= 35% (+3)

## Distance walked in 6-Minute Walk Distance
E. >= 350 m (+0)
F. 250-349 m (+1)
G. 150-249 m (+2)
H. <= 149 m (+3)

## MMRC Dyspnea Scale
I. Dyspnea only with strenuous exercise (+0)
J. Dyspnea when hurrying or walking up a slight hill (+0)
K. Walks slower than people of same age because of dyspnea or stops for breath when walking at own pace (+1)
L. Short of breath after walking a few minutes or 100 yards (91 m) (+2)
M. Too breathless to leave house or breathless when dressing (+3)

## Body mass index
N. > 21 (+0)
O. <= 21 (+1)
---
# Scoring:
- If score <= 2, then 4-year survival is 80%
- If score <= 4, then 4-year survival is 67%
- If score <= 6, then 4-year survival is 57%
- If score <= 10, then 4-year survival is 18%
- If score == 0, then Please make a selection)

The DECAF Score is a clinical calculator used for patients with Chronic Obstructive Pulmonary Disease (COPD). DECAF stands for Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation. This scoring system is used to predict the in-hospital mortality risk of patients admitted with acute exacerbations of COPD. 

The DECAF score is applicable to patients with a confirmed diagnosis of COPD who are experiencing an acute exacerbation severe enough to warrant hospital admission. It is not suitable for use in patients without a COPD diagnosis, those with stable COPD, or those with other primary causes of respiratory distress. The score helps clinicians to make informed decisions about the level of care required, including the need for intensive care admission.

DECAF score for COPD

# Description:
The DECAF Score is a clinical calculator used for patients with Chronic Obstructive Pulmonary Disease (COPD). DECAF stands for Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation. This scoring system is used to predict the in-hospital mortality risk of patients admitted with acute exacerbations of COPD. 

The DECAF score is applicable to patients with a confirmed diagnosis of COPD who are experiencing an acute exacerbation severe enough to warrant hospital admission. It is not suitable for use in patients without a COPD diagnosis, those with stable COPD, or those with other primary causes of respiratory distress. The score helps clinicians to make informed decisions about the level of care required, including the need for intensive care admission.
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# Inputs:
## eMRCD (level of breathlessness on a good day within the last 3 months)
A. eMRCD 1-4 (+0)
B. eMRCD 5a (too dyspneic to leave the house, but independent with washing/dressing) (+1)
C. eMRCD 5b (too dyspneic to leave the house, requires washing/dressing) (+2)

## Eosinopenia (eosinophils < 0.05×10**9/L)
D. Yes (+1)
E. No (+0)

## Consolidation on chest X-ray
F. Yes (+1)
G. No (+0)

## Moderate to severe acidemia (pH < 7.3)
H. Yes (+1)
I. No (+0)

## Atrial fibrillation (past or present)
J. Yes (+1)
K. No (+0)
---
# Scoring:
- If score == 0, then Low risk group with 0% in-hospital mortality
- If score == 1, then Low risk group with 1.5% in-hospital mortality
- If score == 2, then Intermediate risk group with 5.4% in-hospital mortality
- If score == 3, then High risk group with 15.3% in-hospital mortality
- If score == 4, then High risk group with 31% in-hospital mortality
- If score == 5, then High risk group with 40.5% in-hospital mortality
- If score == 6, then High risk group with 50% in-hospital mortality)

The COPD Assessment Test (CAT) is a clinical calculator used specifically for patients with Chronic Obstructive Pulmonary Disease (COPD). This scoring system is designed to measure the impact of COPD on a person's life, and how this changes over time. It is a patient-completed instrument that helps to quantify the impact of COPD symptoms on health status. The CAT score is used to guide treatment decisions, assess disease progression, and evaluate the effectiveness of treatments in COPD patients. It is not suitable for use in patients without a confirmed diagnosis of COPD or in those with other respiratory disorders as it is specifically designed for COPD.

COPD Assessment Test (CAT)

# Description:
The COPD Assessment Test (CAT) is a clinical calculator used specifically for patients with Chronic Obstructive Pulmonary Disease (COPD). This scoring system is designed to measure the impact of COPD on a person's life, and how this changes over time. It is a patient-completed instrument that helps to quantify the impact of COPD symptoms on health status. The CAT score is used to guide treatment decisions, assess disease progression, and evaluate the effectiveness of treatments in COPD patients. It is not suitable for use in patients without a confirmed diagnosis of COPD or in those with other respiratory disorders as it is specifically designed for COPD.
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# Inputs:
## Cough
A. 0 (“I never cough”) (+0)
B. 1 (+1)
C. 2 (+2)
D. 3 (+3)
E. 4. (+4)
F. 5 (“I cough all the time”) (+5)

## Phlegm
G. 0 (“I have no phlegm in my chest at all”) (+0)
H. 1 (+1)
I. 2 (+2)
J. 3 (+3)
K. 4 (+4)
L. 5 (“My chest is completely full of phlegm”) (+5)

## Chest tightness
M. 0 (“My chest does not feel tight at all”) (+0)
N. 1 (+1)
O. 2 (+2)
P. 3 (+3)
Q. 4 (+4)
R. 5 (“My chest feels very tight”) (+5)

## Breathlessness
S. 0 (“When I walk up a hill or one flight of stairs I am not breathless”) (+0)
T. 1 (+1)
U. 2 (+2)
V. 3 (+3)
W. 4 (+4)
X. 5 (“When I walk up a hill or one flight of stairs I am very breathless”) (+5)

## Activities
Y. 0 (“I am not limited doing any activities at home”) (+0)
Z. 1 (+1)
AA. 2 (+2)
AB. 3 (+3)
AC. 4 (+4)
AD. 5 (“I am very limited doing any activities at home”) (+5)

## Confidence
AE. 0 (“I am confident leaving my home despite my lung condition”) (+0)
AF. 1 (+1)
AG. 2 (+2)
AH. 3 (+3)
AI. 4 (+4)
AJ. 5 (“I am not at all confident leaving my home because of my lung condition”) (+5)

## Sleep
AK. 0 (“I sleep soundly”) (+0)
AL. 1 (+1)
AM. 2 (+2)
AN. 3 (+3)
AO. 4 (+4)
AP. 5 (“I don't sleep soundly because of my lung condition”) (+5)

## Energy
AQ. 0 (“I have lots of energy”) (+0)
AR. 1 (+1)
AS. 2 (+2)
AT. 3 (+3)
AU. 4 (+4)
AV. 5 (“I have no energy at all”) (+5)
---
# Scoring:
- If score <= 10, then Low health impact
- If score <= 20, then Medium health impact
- If score <= 30, then High health impact
- If score <= 40, then Very high health impact
- If score == 0, then Please make a selection)

The Modified Medical Research Council (mMRC) Dyspnea Scale is a clinical calculator used to assess the level of breathlessness in patients with respiratory diseases, particularly chronic obstructive pulmonary disease (COPD). The scale ranges from 0 to 4, with 0 indicating no breathlessness except with strenuous exercise and 4 indicating breathlessness while at rest. The mMRC Dyspnea Scale is a simple and effective tool for evaluating the impact of dyspnea on daily activities and quality of life. It is also used to guide treatment decisions and predict health outcomes in patients with COPD. There are no specific exclusion criteria for its use, but it may be less accurate in patients with conditions that cause dyspnea other than COPD.

Modified Medical Research Council (mMRC) dyspnea scale

# Description:
The Modified Medical Research Council (mMRC) Dyspnea Scale is a clinical calculator used to assess the level of breathlessness in patients with respiratory diseases, particularly chronic obstructive pulmonary disease (COPD). The scale ranges from 0 to 4, with 0 indicating no breathlessness except with strenuous exercise and 4 indicating breathlessness while at rest. The mMRC Dyspnea Scale is a simple and effective tool for evaluating the impact of dyspnea on daily activities and quality of life. It is also used to guide treatment decisions and predict health outcomes in patients with COPD. There are no specific exclusion criteria for its use, but it may be less accurate in patients with conditions that cause dyspnea other than COPD.
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# Inputs:
## Assessment of dyspnea
A. Dyspnea only with strenuous exercise (0)
B. Dyspnea when hurrying or walking up a slight hill (+1)
C. Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace (+2)
D. Stops for breath after walking 100 yards (91 m) or after a few minutes (+3)
E. Too dyspneic to leave the house or dyspneic when dressing or undressing (+4)
---
# Scoring:
- If score == 0, then Grade 0. Higher grade suggests higher severity.
- If score == 1, then Grade 1. Higher grade suggests higher severity.
- If score == 2, then Grade 2. Higher grade suggests higher severity.
- If score == 3, then Grade 3. Higher grade suggests higher severity.
- If score == 4, then Grade 4. Higher grade suggests higher severity.)

The Clinical Frailty Scale (CFS) is a tool used to assess the level of frailty in older adults, typically those aged 65 and above. The scale is designed to provide a measure of the patient's vulnerability to adverse outcomes, including disability, hospitalization, and mortality. The CFS is particularly useful in geriatric medicine, where it can help guide treatment decisions and care planning. It is based on patient's physical activity, energy, physical ability, and health changes. The scale ranges from 1 (very fit) to 9 (terminally ill). The CFS may not be appropriate for use in younger populations or in individuals with primarily cognitive impairment, as it does not specifically assess cognitive function.

Clinical Frailty Scale

# Description:
The Clinical Frailty Scale (CFS) is a tool used to assess the level of frailty in older adults, typically those aged 65 and above. The scale is designed to provide a measure of the patient's vulnerability to adverse outcomes, including disability, hospitalization, and mortality. The CFS is particularly useful in geriatric medicine, where it can help guide treatment decisions and care planning. It is based on patient's physical activity, energy, physical ability, and health changes. The scale ranges from 1 (very fit) to 9 (terminally ill). The CFS may not be appropriate for use in younger populations or in individuals with primarily cognitive impairment, as it does not specifically assess cognitive function.
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# Inputs:
## Description of fitness/frailty
A. Robust, active, energetic, and motivated; these people commonly exercise regularly and are among the fittest group for their age.
B. No active disease symptoms, but less fit than people in the category above. Often, they exercise or are very active occasionally, such as seasonally.
C. Disease symptoms are well controlled compared with those in the category below, but are not regularly active beyond routine walking.
D. Although not dependent on others for daily help, symptoms often limit activities and a common complaint is being :slowed up", and/or being tired during the day.
E. More evident slowing, and need help in high order instrumental activities of daily living (finances, transportation, heavy housework, medications). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation, and housework.
F. Help is needed with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing.
G. Completely dependent for personal care, from whatever cause (physical or cognitive). Even so, these people seem stable and not at high risk of dying (within ~6 months).
H. Completely dependent, approaching the end of life. Typically, they could not recover even from a minor illness.
I. Approaching the end of life. This category applies to people with a life expectancy < 6 months, who are not otherwise evidently frail.
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# Scoring:
- If A, then Very fit
- If B, then Well
- If C, then Managing well
- If D, then Vulnerable
- If E, then Mildly frail
- If F, then Moderately frail
- If G, then Severely frail
- If H, then Very severely frail
- If I, then Terminally ill
- If true, then Please make a selection)