Prognostic Power of the BCSS in Severe COPD

The Breathlessness, Cough and Sputum Scale, used to evaluate COPD treatment efficacy, may help predict exacerbations in severe disease.

The Breathlessness, Cough and Sputum Scale (BCSS) is a three-item questionnaire that uses a 5-point Likert scale to evaluate the severity of COPD symptoms (0=no symptoms, 4=severe symptoms) that has been used in clinical trials to evaluate the efficacy of treating a COPD exacerbation. A recent study set out to determine whether the BCSS scale can be used to predict a COPD exacerbation

[[{"type":"media","view_mode":"media_crop","fid":"54921","attributes":{"alt":"Linda Bucklin/ ","class":"media-image media-image-right","height":"201","id":"media_crop_6482333934708","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6877","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"","typeof":"foaf:Image","width":"176"}}]]The Validation of the breathlessness, cough, and sputum scale to predict COPD exacerbation study was a prospective case-crossover study. Subjects were 168 patients (97% white) seen for severe to very severe COPD at a disease management group in central Massachusetts. Responses to the BCSS questionnaire were given during an exacerbation (n=231) and at a random point in time during an exacerbation-free period (n=389).

Higher BCSS Score Ups Odds of Exacerbation

 â–º Higher BCSS score linked to greater odds of COPD exacerbation (OR=2.80, 95% CI=2.27–3.45)

 â–º Each one point increase in score increased the odds of exacerbation by 180%

 â–º BCSS sum score 5.0: 83% sensitivity and 68% specificity for identifying a COPD exacerbation

Authors Weigh in on Utility

THe BCSS proved accurate in predicting clinically confirmed COPD exacerbations, findings the authors note are particularly valuable as objective measures of COPD severity (changes in pulmonary function) often do not correlate well with subjective measures (changes in symtpoms).

 “We conclude that the use of a simple three-item questionnaire may provide an easy and accurate way to identify patients who are at risk of exacerbation to expedite interventions of COPD exacerbation,” wrote first author Rebecca Devries, ScD, of the University of Massachusetts, and colleagues.

Take-Home Points

► The Breathlessness, Cough and Sputum Scale is a three-item questionnaire that evaluates COPD symptoms 
► Study found that increased BCSS scores are linked to increased odd of a COPD exacerbation 
► A score of 5.0 on the BCSS scale is a good indication of an impending COPD exacerbation, with a fairly good false negative rate 
► The BCSS may be a simple, easy to use tool to identify COPD patients at risk for exacerbation and in need of intervention


The study was funded by the US National Institute for Environmental Health Sciences; rhe authors report no conflicts of interest.

Source: DeVries R, Kriebel D, Sama S. Validation of the breathlessness, cough and sputum scale to predict COPD exacerbation. NPJ Prim Care Respir Med. 2016 Dec 1;26:16083. doi: 10.1038/npjpcrm.2016.83.


Image ©Linda Bucklin/


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