[COPD: what is there beyond BODE index?]

Chronic obstructive pulmonary disease (COPD) is a multidimensional disease with wide phenotypic heterogeneity that is not adequately reflected by forced expiratory volume in 1 second (FEV(1)). Assessment of patients with COPD requires analysis of multiple variables that encompass respiratory and extrapulmonary involvement. These variables should be viable in clinical practice, should not provide duplicate information, and should have an effect on the course of the disease. The BODE index (FEV(1), dyspnea, body mass index and the 6-minute walk test) is the most obvious example of this conceptual approach and its acceptance among the scientific community has grown in the last few years. Nevertheless, other aspects of the disease not included in the BODE index, such as pulmonary hyperinsufflation, exacerbations and comorbidities, have been shown to be important in COPD. Moreover, the development of new technologies could allow imaging techniques and biomarkers to be incorporated, which would in turn improve characterization of the disease and allow more specific and individually-tailored patient management. Nevertheless, the role of all these factors in the evaluation of a highly prevalent disease such as COPD remains to be defined.