Consensus for managing patients with chronic obstructive pulmonary disease according to the CODEX index

The comorbidity, obstruction, dyspnoea, exacerbations (CODEX) index is the first multicomponent scale designed to predict the risk of readmissions and mortality at 1 year for patients hospitalised for chronic obstructive pulmonary disease (COPD). The index includes the comorbidities (C) (measured by the Charlson index), the degree of obstruction (O) (assessed by the forced expiratory volume in 1 second percentage), dyspnoea (D) (stratified according to the modified Medical Research Council scale) and exacerbations (EX) in the previous year. Our objective was to prepare recommendations based on the index's various components for personalised therapeutic management. To this end, we performed a literature search based on guidelines, consensuses and systematic reviews, as a basis for preparing recommendations on basic concepts, comorbidities, dyspnoea, pulmonary obstruction, exacerbations and follow-up. The recommendations were then subjected to an external assessment process by a multidisciplinary group of 62 experts. In total, 108 recommendations were created, 96 of which achieved consensus, including the recommendation that COPD be considered a high-risk cardiovascular disease, as well as several specific recommendations on managing the various comorbidities. A consensus was reached on the recommended treatments in the guidelines for the various levels of obstruction, dyspnoea and exacerbations, adapted to the CODEX scores. Advice is also offered for patient follow-up after hospital discharge, which includes aspects on assessment, treatment and care coordination.