Global assessment of the COPD patient: Time to look beyond FEV1?
COPD is a diverse disease entity with multiple dimensions that uniquely define the patient's performance, morbidity and mortality. FEV1 is both the traditional metric used to define the progression of COPD as well as the strongest spirometric predictor of mortality in COPD patients. However, besides pulmonary functional abnormalities, COPD is also associated with significant systemic effects. Therefore, the global assessment of an affected patient should include different aspects of the consequences of this disorder, beyond the "gold-standard" assessment of airflow limitation. Quantification of the patient's dyspnea, body composition as expressed by BMI, simple measures of exercise capacity such as the 6MWD, assessment of comorbidities and identification of characteristics related to different phenotypes are features that may lead to more optimal management of such patients. (C) 2009 Elsevier Ltd. All rights reserved.