### Description

Niewoehner et al developed a score for predicting exacerbations in a patient with chronic obstructive pulmonary disease (COPD). This can help identify a patient who may benefit from more aggressive management. The authors are from multiple Veterans Affairs hospitals across the United States.

Parameters:

(1) age of the patient in years

(2) observed FEV1 as percent of predicted

(3) productive cough

(4) theophylline therapy at entry

(5) duration of COPD in years

(6) course of antibiotics for COPD during the prior year

(7) number of courses of systemic steroids for COPD during the prior year

(8) hospital admissions for COPD during the prior year

Parameter

Finding

Points

age of the patient in years

< 45 years

0

45 to 54 years

20

55 to 64 years

40

65 to 74 years

60

75 to 84 years

80

>= 85 years

100

FEV1 as percent of predicted

10 to 19%

75

20 to 29%

66

30 to 39%

56

40 to 49%

47

50 to 59%

38

60 to 69%

28

>= 70%

0

productive cough

absent

0

present

31

theophylline therapy at entry

no

0

yes

26

duration of COPD

1 year

0

2 years

5

3 years

9

4 years

14

5 years

19

6 years

23

7 years

28

>= 8 years

33

course of antibiotics for COPD

0

0

>= 1

63

courses of systemic steroids

0

0

1

39

>= 2

70

0

0

>= 1

24

where:

• An FEV1 < 10% of predicted is probably incompatible with life. An FEV1 >= 70% of predicted can be handled in several ways. For the implementation I set it to 0.

total score =

= SUM(points for all 8 parameters)

Interpretation:

• minimum score: 0

• maximum score: 422

• The higher the score the greater the risk of an exacerbation of the COPD.

Total Score

Percent probability of an exacerbation within 6 months

< 50

< 7%

50 to 250

(0.000444 * ((points)^2)) + (0.01629 * (points)) + 5.946

250 to 425

(-0.000148 * ((points)^2)) + (0.4008 * (points)) - 53.54