These data suggest that detailed end-of-life discussions with newly diagnosed COPD Lung Disease patients would be premature and irrelevant, but a stop-smoking intervention at this early stage of COPD Lung Disease would save lives.Respiratory failure is the most likely cause of death among patients with more advanced COPD. The BODE index combines four easily obtained patient variables (body mass index, airflow obstruction, dyspnea, and exercise tolerance) and has been validated as a prognostic tool in COPD Lung Disease.A trial of the index followed 625 patients over a 5-year period during which 162 (26%) died. Survivors averaged an FEV1 of 43% of predicted and nonsurvivors averaged 28% of predicted.
(Normal values would be above 80% of predicted.) The leading cause of death was respiratory failure (61%), with myocardial infarction (14%) and lung cancer (12%) causing a minority of deaths.These COPD Lung Disease patients are more representative of those seen by caregivers in clinics and hospitals. End-of-life discussions would be highly relevant for these patients with their more advanced airflow limitation.As ill as members of the BODE cohort were, only 26% died during the 5-year trial. Most patients survived for several years. However, the trial still validated the prognostic value of the BODE index by identifying a group of patients with COPD at very high risk of death. Patients with the highest BODE index scores had a 5-year mortality of 80%, with about half of these patients surviving less than 44 months. It is clear that this is the cohort of COPD patients most appropriate for an end-of-life discussion.