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International Medical Scientific Journal        Issue-2 
10.5281/zenodo.5564196 

203 

  



Art of Medicine           Volume-1 

International Medical Scientific Journal        Issue-2 
10.5281/zenodo.5564196 

204 

 

Art of Medicine International Medical Scientific journal 

 

Founder and Publisher Pascual Izquierdo-Egea 

Published science may 2021 year. Issued Quarterly.  

Internet address: http://artofmedicineimsj.us 

E-mail: info@artofmedicineimsj.us 

11931 Barlow Pl Philadelphia, PA 19116, USA +1 (929) 266-0862 

 

 

 

  



Art of Medicine           Volume-1 

International Medical Scientific Journal        Issue-2 
10.5281/zenodo.5564196 

205 

 

Expert assessment of survival prognosis and optimization of approaches to early 
examination of patients with chronic obstructive pulmonary disease. 

 

Liverko I.V., Tashmetova G.T. 

Republican specialized scientific and practical medical center of tuberculosis and 

pulmonology 

Center for the Development of Professional Qualifications of Medical Workers 
Tashkent, Uzbekistan  

 

Abstract. The results of the analysis showed that among the cohort of patients with 
COPD with a BODE index of more than 5 and according to the results of the CAT 

test, which determines a serious impact on the daily life of patients (more than 30 

points), the proportion of disabling conditions is high: pulmonary hypertension (62.6% 

and 42, 2%, respectively), cor pulmonale (37.4% and 21.9%, respectively), 
confirming the need for primary examination of this category of patients, where it is 

expected for the first time to establish disability in every 3-4 patients from this cohort 

of patients. 
Keywords. BODE, COPD, FEV1, BMI.  

 

Introduction. Questions of expert early examination of patients with COPD in 

the category of vital activity: the ability to self-service, movement, work activity and 
the establishment of their limitations in terms of severity has an important aspect for 

predicting the progression of the disease, determining the early terms of social 

rehabilitation measures. 

The steadily progressive course of COPD leads to the development of early 
disability and a decrease in life expectancy. Severe concomitant diseases in COPD, 

advanced age of patients, progressive emphysema, the development of respiratory 

and heart failure are unfavorable prognostic signs [2; p. 1-36]. Further evolution is a 
progressive restriction of air flow, increased pressure in the pulmonary artery, the 

development of hypertrophy of the right ventricle and cor pulmonale [4; c.1-6]. With 

the progression of obstruction, patients become less and less mobile, this leads to 

muscle and cardiovascular disorders, and an increase in disability. The growth of 
disability contributes to depression, social isolation, which is widespread among 

seriously ill COPD [3]. In advanced stages of COPD, severe pulmonary hypertension 

is a serious complication, which predicts an increased frequency of exacerbations.  
Disability in COPD is established late and is established almost immediately - 

the second group. The life expectancy of disabled people with COPD is no more than 

6 years on average, which is 3.5 times less than in BA [1; c. 221-232].   

The aim of this study was to conduct an expert assessment of the prognosis of 
survival and optimization of approaches to early examination of patients with chronic 

obstructive pulmonary disease.. 



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206 

Material and research methods. A total of 340 patients with COPD were 

examined. Clinical and functional data of patients with COPD were assessed, 
including the main parameters - BMI (body mass index), MRC (dyspnea scale of the 

Medical Research Council), FEV1 (forced expiratory volume in the first second), 6-

MST (six-minute step test), which determine prognostic outcomes the survival rate of 
patients with COPD and indicators of the effect of the disease according to the CAT 

test (the effect of COPD on the patient's daily life and health).  

Research results. Assessment of the clinical and functional data of patients 

with COPD, including the main parameters - BMI, MRC, FEV1, 6-MST, which 
determine the prognostic survival outcomes of patients with COPD and indicators of 

the effect of the disease according to the CAT test are presented in Table 1.  

                                Table 1. 

Characteristics of clinical and functional parameters in patients with COPD 

(n = 340) 

Factors 

 

 

n 

COPD 

Functional degree of COPD 

I stage, 

n=25 

II stage, 

n=56 

III stage, 

n=100 

IV stage, 

n=159 

BMI, kg / m 
2 

340 23,5±2,5 24,3±1,2 22,1±2,6 20,8±1,9 18,1±2,4 

MRC, points 340 3,1±1,1 0,9±0,3 1,9±0,3 2,6±0,5 3,5±0,4* 

FEV1,% from 

due 

340 48,4±2,1 81,4±1,1 63,8±3,1* 43,8±2,4* 33,8±1,4* 

6- MShT, m 340 171,9±11,2 301,9±19,5 241,9±11,5 151,9±10,2* 125,8±13,8* 

CAT test, 

points 

340 30,5±5,5 9,3±1,2 16,1±3,6 29,8±2,5* 35,1±1,4* 

 

From the presented table it can be seen that with the severity of the functional 

stage, the severity of the clinical manifestations of the disease increases, in particular, 
the intensity of shortness of breath from 0.9 ± 0.3 to 3.5 ± 0.4 points, the 6-MST 

indices decrease by 58.3% and manifestations of nutritional deficiency are increasing, 

accompanied by a decrease in BMI by 25.5%, and the degree of influence of the 

disease on the patient's life increases by 4 times from a level of insignificant 
influence (9.3 ± 1.2 points) to a serious (35.1 ± 1, 4 points). 

Analysis of clinical and functional parameters with the calculation of the BODE 

index in patients with COPD showed that 25% of patients with COPD had a 
calculated BODE index, which determines the 80% probability of 4-year survival (in 

a grading of 0-2 points); 30% of patients with COPD had a 67% probability of 4-year 

survival with a calculated BODE index of 3-4 points; in 27.6% of patients with 

COPD - 57% probability of 4-year survival with the calculated data of the BODE 



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index of 5-6 points; 17.4% of patients with COPD had a probability of 18% 4-year 

survival according to the BODE index from 7 to 10 points. 
The assessment of the disease outcome by the BODE index was compared with 

the indicators of the CAT result, which determines the impact of COPD on the 

patient's daily life and health (Table 2). 
 

Table 2 

Comparison of the results of estimates of the BODE index and CAT 

 

Points 

total 

by BODE 
index, 

score 

 

 N 

Impact of COPD on the patient's daily life and health, score 

Minor 

0-10 

Moderate 

11-20 

Expressed 

21-30 

Serious 

31-40 

0-2  85 25(29,4±4,9) 56(65,9±5,1) 4(4,7±2,3) - 

3-4 102 1(1,0±1,0) 1(1,0±1,0) 74(72,5±4,4) 26(25,5±4,3) 

5-6 94 - 1(1,1±1,1) 20(21,3±4,2) 73(77,7±4,3) 

7-10 59 - - 2(3,4±2,4) 57(96,6±2,3) 

 
According to the results of the study, a high correlation was established 

between the BODE index and the results of CAT (r = 0.83). It was noted that with a 

decrease in the percentage of 4-year survival, there is a tendency for the aggravation 

of the serious impact of COPD on the daily life and health of the patient from 25.5% 
to 96.6%. 

The results of the study compared the clinical and functional parameters that 

determine the clinical status of the severity of COPD disease, which had a previously 
established group of disability for respiratory diseases (Table 3).  

Table 3 

Frequency of scoring criteria in patients with COPD with and without 

disabilities 

 

Indicator by 

indicators 

Score in 

points 

COPD patients 
with an established 

invalidity, n = 82 

without established 

disability, n = 258 

B
M

I,
 k

g
 /

 m
 2

 

More than 

21 

0  29(35,4±5,3) 249(95,6±1,3) 

Less than 

21 

1 53(64,6±5,3)* 9(4,4±1,3) 

F E V 1 , %  d u e Over 65 0 1(1,2±1,2) 114(44,2±3,1) 



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208 

50-64 1 11(13,4±3,8) 86(33,3±2,9) 

36-49 2 25(30,5±5,1)* 38(14,7±2,2) 

Less than 

35 

3 45(54,8±5,5)* 20(7,7±1,6) 

6
-M

S
h

T
, 
m

 

More than 

350 

0 - 110(42,6±3,1) 

250-349 1 9(11,0±3,4) 90(34,9±3,0) 

150-249 2 29(35,4±5,3)* 31(12,0±2,0) 

Less than 
149 

3 44(53,6±5,5)* 27(10,5±1,9) 

M
R

C
, 

sh
o

rt
n

es
s 

o
f 

b
re

at
h
 0-1 0 1(1,2±1,2) 116(45,0±3,1) 

2 1 4(4,9±2,4) 80(31,0±2,9) 

3 2 22(26,8±4,9)* 38(14,7±2,2) 

4 3 55(67,1±5,2)* 24(9,3±1,8) 

Note: * reliability of the difference between the indicator values (p <0.05). 
As can be seen from the presented table, the assessment of individual 

functional parameters cannot accurately reflect the degree of functional disorders and 

objectively serve as a criterion for assessing the ability to work. So, up to 14.6% of 
disabled people had FEV1 parameters of more than 50% of the required value, up to 

11.0% - had the result of 6 MST more than 250 m (more than 75% of the required 

value) and 6.1% of patients had an assessment of the degree of cough by MRC not 

more than 3 points. Also, COPD patients without established disability had certain 
disorders that determine the possible degree of disability, which were characterized 

by a pronounced degree of functional impairment by a decrease in FEV1 of less than 

50% of what should be and the results of 6 MST less than 250 m and were 45.0% in 
the cohort of COPD patients without disability. ... 

The evaluated functional criteria, allowing to accentuate the degree of the 

functional class of the disease, were ranked according to the sum of points, where 0-3 

points - functional class I; 4-6 points - functional class II, 7-10 points - functional 
class III, and analyzed by the frequency of their occurrence in cohorts of COPD 

patients with and without disabilities (Fig. 1). 



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Fig. 1. Frequency of occurrence of functional classes of the disease in COPD 

 

In the cohort of COPD patients with disabilities, there was a trend towards an 

increase in the functional class of COPD disease from 11.0% to 52.4%. 

Assessment of the integral BODE index in COPD patients with an established 
disability group shows that only 24.4% have a 4-year survival rate of more than 57% 

(Table 4). From the presented table it can be seen that 90% of patients with COPD, 

with an existing III disability group, had an 80% probability of 4-year survival; 46.1% 

of patients with COPD in group II and 71.4% of patients with COPD in group I had 
an 18% probability of 4-year survival. 

Table 4 

Percentage rate of 4-year survival in COPD patients with various 

disabilities 

 

Disability group  4-year survival rate 

80% 67% 57% 18% 

III 10 9(90,0±10,0) 1(10,0±10,0) - - 

II 65 1(1,5±1,5) 9(13,8±4,3) 25(38,5±6,0) 30(46,2±6,2) 

I 7 - - 2(28,6±18,4) 5(71,4±18,4) 

 82 10(12,2±3,6) 10(12,2±3,6) 27(32,9±5,2) 35(42,7±5,5) 

 

Assessment of the impact of the disease on the daily life of COPD patients with 
an established disability group shows that only 26.8% have a slight or moderate 

impact on the patient's life according to the results of the CAT test (Table 5). 

Table 5 

Assessment of the impact of COPD on the daily life and health of a COPD 

patient with disabilities 

 

Disability  Impact of COPD on the patient's daily life and health, score 

0

20

40

60

80

100

I FC II FC III FC

11 

36,6 

52,4 

94,2 

4,6 1,2 

Disability No disability



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group  N Minor 

0-10 

Moderate 

11-20 

Expressed 

21-30 

Serious 

31-40 

III 10 6(60,0±16,3) 3(30,0±15,1) 1(10,0±10,0) - 

II 65 1(1,5±1,5) 12(18,5±4,8) 30(46,1±6,2) 22(33,8±5,9) 

I 7 - - 1(14,3±14,3) 6(85,7±14,3) 

Total 82 7(8,5±1,5) 15(18,3±4,3) 32(39,0±5,4) 28(34,1±5,2) 

 
The used assessment of expert examination of patients with COPD is based on 

parameters reflecting the severity of obstruction and hemodynamic disorders, taking 

into account the nature of the patient's work activity and concomitant pathology, 
today, without taking into account and assessing the integral indicators of the BODE 

index, which determine the probability of the percentage of 4-year survival and 

outcomes CATs assessing the impact of COPD on a patient's daily life may not 

reflect a valid level of expert judgment. 
Analysis of the occurrence of functional and hemodynamic criteria that 

determine the assessment of expert examination of patients with COPD in a cohort of 

individuals with a 57% probability of 4-year survival and the level of serious impact 
of COPD on the patient's daily life is presented in Table 6..  

Table 6 

Frequency of occurrence of functional and hemodynamic criteria that 

determine the assessment of expert examination of patients with COPD 

 

COPD 

patients 

with 

indicator 
values 

 

 

 

n 

Functional and hemodynamic parameters 

SDLA 
more 

than 25 

mm Hg 

Sodi 
Poll 

Rice 

Index 
less than 

10 

PII-III 
more 

than 2 

for physical activity 

the rise decline 

Heart rate 
over 15% 

NP more 
than 

20% 

saturation 
by more 

than 3% 

CAT 

more 

than 30 
points 

128 54 

42,2±4,

4 

31 

24,2±3,8 

28 

21,9±3,

5 

36 

28,1±3,6 

40 

31,2±4,1 

26 

20,3±3,5 

BODE 

Index 5 

and 

more 

 

91 

57 

62,6±5,

1 

 

32 

35,2±5,0 

34 

37,4±5,

1 

30 

33,0±4,9 

42 

46,1±5,2 

33 

36,3±5,1 

 
The results of the analysis showed that among the cohort of patients with COPD 

with a BODE index of more than 5 and according to the results of the CAT test, which 

determines a serious impact on the daily life of patients (more than 30 points), there is a 

high proportion of disabling conditions: pulmonary hypertension (62.6% and 42, 2%, 
respectively), cor pulmonale (37.4% and 21.9%, respectively), confirming the need for 



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primary examination of this category of patients, where it is expected for the first time to 

establish disability in every 3-4 patients from this cohort of patients. 

 

 

 

Conclusions:  
1. The high diagnostic significance of the integral estimates of the BODE index and 

the results of the CAT test in the issues of early examination of patients with COPD 

was stated. 
2. These integral indices have a high correlation with clinical and functional 

indicators that determine the severity of the disease and its functional classes, and 

their close correlation with the disability group has been established, which determine 

persistent disability..  
 

 

  



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2. Chuchalin A.G. et al. Federal clinical guidelines for the diagnosis and treatment 

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