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DOI: 10.1016/j.rceng.2019.03.022
Available online 18 May 2019
Consensus for managing patients with chronic obstructive pulmonary disease according to the CODEX index
Consenso para el manejo de pacientes con EPOC según el índice CODEX
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R. Boixedaa, J. Díez-Manglanob, M. Gómez-Antúnezc, F. López-Garcíad, J. Recioe, P. Almagrof,
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19908pam@comb.cat

Corresponding author.
a Servicio de Medicina Interna, Hospital de Mataró, Mataró, Barcelona, Spain
b Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
c Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Servicio de Medicina Interna, Hospital General de Elche, Elche, Alicante, Spain
e Servicio de Medicina Interna, Hospital Vall d’Hebron, Barcelona, Spain
f Unidad de paciente crónico complejo, Servicio de Medicina Interna, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
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Table 1. Consensus recommendations with ≥95% agreement associated with the patient's comorbidities.
Table 2. Consensus recommendations with ≥95% agreement associated with the patient's pulmonary function according to the forced expiratory volume in 1 second.
Table 3. Consensus recommendations with ≥95% agreement associated with the patient's degree of dyspnea according to the modified dyspnea scale.
Table 4. Consensus recommendations with ≥95% agreement associated with the patient's severe exacerbations.
Table 5. Consensus recommendations with ≥95% agreement regarding the basic concepts of management and follow-up of patients with chronic obstructive pulmonary disease.
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Abstract

The comorbidity, obstruction, dyspnea, 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), dyspnea (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 personalized 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, dyspnea, 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, dyspnea 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.

Keywords:
Chronic obstructive pulmonary disease
Disease severity index
Prognosis
Mortality
Consensus
CODEX
Resumen

El índice CODEX es la primera escala multicomponente diseñada para predecir el riesgo de mortalidad y reingresos al año en los pacientes hospitalizados por EPOC. Su cálculo incluye las comorbilidades medidas por el índice de Charlson (C), el grado de obstrucción valorado por el FEV1% (O), la disnea estratificada según la escala modificada del Medical Research Council (D) y las exacerbaciones en el año previo (EX). Nuestro objetivo fue elaborar recomendaciones basadas en los diferentes componentes del índice para un manejo terapéutico personalizado.

Para ello se realizó una búsqueda bibliográfica basada en guías, consensos y revisiones sistemáticas, como base para elaborar recomendaciones sobre: generalidades, comorbilidades, disnea, obstrucción pulmonar, exacerbaciones y seguimiento. Seguidamente, se sometieron a un proceso de valoración externo por un grupo multidisciplinar de 62 expertos.

En total se realizaron 108 recomendaciones, de las cuales se alcanzó consenso en 96. Entre ellas se destaca que la EPOC debe considerarse como una enfermedad de riesgo cardiovascular alto y varias recomendaciones específicas sobre el manejo de las diferentes comorbilidades. Se consensuaron los tratamientos aconsejados para los diferentes niveles de obstrucción, disnea y exacerbaciones recomendados en las guías, adaptadas a las puntuaciones del CODEX. Se ofrecen también unos consejos para el seguimiento tras el alta hospitalaria del paciente, en los que se incluyen aspectos sobre la valoración, el tratamiento y la coordinación asistencial.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Índice de gravedad de la enfermedad
Pronóstico
Mortalidad
Consenso
CODEX

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