Abstract
Background and Objectives: In advanced chronic obstructive pulmonary disease (COPD), functional status is significantly impaired mainly as a result of disease related respiratory symptoms such as dyspnea or as a result of fatigue, which is the extra-respiratory symptom the most prevalent in this setting. “Physical” frailty, considered to be an aging phenotype, has defining traits that can also be considered when studying impaired functional status, but little is known about this relationship in advanced COPD. This review discusses the relevance of this type of frailty in advanced COPD and evaluates it utility and its clinical applicability as a potential outcome measure in palliative care for COPD. Materials and Methods: A conceptual review on the functional status as an outcome measure of mortality and morbidity in COPD, and an update on the definition and traits of frailty. Results: Data on the prognostic role of frailty in COPD are rather limited, but individual data on traits of frailty demonstrating their relationship with mortality and morbidity in advanced COPD are available and supportive. Conclusions: Frailty assessment in COPD patients is becoming a relevant issue not only for its potential prognostic value for increased morbidity or for mortality, but also for its potential role as a measure of functional status in palliative care for advanced COPD.
Highlights
Chronic obstructive pulmonary disease (COPD) is a debilitating disease that most commonly develops in smokers and is characterized by progressive respiratory symptoms such as dyspnea or coughing
This relationship was initially demonstrated in cancer patients, in whom a rapid decline in functional status under curative therapy was found to be associated with a poor prognosis and the need for palliative care [3]
This review focused on physical frailty in an attempt to establish its relationship with functional status and to outline the importance of its identification in routine practice, especially in older chronic obstructive pulmonary disease (COPD) patients
Summary
Chronic obstructive pulmonary disease (COPD) is a debilitating disease that most commonly develops in smokers and is characterized by progressive respiratory symptoms such as dyspnea or coughing. Such symptoms significantly impair the ability to exercise and perform daily activities, and lower the quality of life. In such patients, assessment of the functional status is necessary in the more advanced stages of the disease, and in the earlier stages, because the identification of changes in daily activities can improve therapeutic planning and predict when palliative care might be needed for patients with a more severe form of the disease. This review conceptualizes frailty in COPD patients and advocates for its consideration as an attribute of impaired functional status when the need for palliative care should be considered, regardless of age
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