Abstract
BackgroundAlthough frailty is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients, evidence on the frequency of frailty transition is scarce.AimsThe present study aimed to describe the frailty status transition rates over a 2-year period and their associated clinical outcomes in stable COPD patients, and to determine predictors of improvement in frailty status.MethodsWe prospectively included 119 patients with stable COPD (mean age ± SD, 66.9 ± 7.9 years) over a follow-up period of 2 years. Frailty was assessed using the Fried criteria (unintentional weight loss, weakness, exhaustion, low activity level, and slow walking speed). Several demographic, clinical, and health-related variables were measured. We calculated the rates for each of the frailty transitions (no change, improvement, or worsening) between baseline and 2 years. Outcomes were compared using one-way analysis of variance and predictors of improvement were identified in multivariate logistic regression.ResultsAfter 2 years of follow-up, 21 (17.6%) patients had an improved frailty status, 14 (11.7%) had worsened, and 84 (70.5%) had maintained the same frailty status. The worsening group (vs no change group) had greater dyspnea (p = 0.013) and disability (p = 0.036) and lower handgrip strength (p = 0.001). In contrast, the improved group (vs no change group) had greater handgrip (p<0.001) and quadriceps strength (p = 0.032). Furthermore, the improved group had greater handgrip strength (p<0.001), quadriceps strength (p = 0.003), physical activity (p = 0.008), and lower disability (p = 0.019) than the worsening group. Additionally, we determined that the 5STS test (≤ 13.6s) and exacerbations (≥ 2) were independent predictors for improvement in frailty status [adjusted OR 9.46, p = 0.058 and adjusted OR 0.12, p = 0.026, respectively].ConclusionsFrailty is a dynamic process for approximately one-third of patients with stable COPD and transitions in frailty status are associated with significant changes in clinical outcomes. The 5STS and exacerbations were independent predictors of improvement in frailty status.
Highlights
Frailty is a geriatric syndrome characterized by multisystem decline leading to reduced functional reserve and increased vulnerability to adverse outcomes [1]
We determined that the 5STS test ( 13.6s) and exacerbations ( 2) were independent predictors for improvement in frailty status [adjusted Odds Ratio (OR) 9.46, p = 0.058 and adjusted OR 0.12, p = 0.026, respectively]
Frailty is a dynamic process for approximately one-third of patients with stable chronic obstructive pulmonary disease (COPD) and transitions in frailty status are associated with significant changes in clinical outcomes
Summary
Frailty is a geriatric syndrome characterized by multisystem decline leading to reduced functional reserve and increased vulnerability to adverse outcomes [1]. A validated phenotype of physical frailty has been shown to predict incident and worsening disability, hospitalizations, and mortality [2,3]. According to this well-established and validated model, frailty comprises five individual physical characteristics: unintentional weight loss, low physical activity, exhaustion, slow walking speed, and low grip strength. Frailty has been traditionally associated with age, patients with chronic obstructive pulmonary disease (COPD) often present with extrapulmonary clinical manifestations frequently associated with frailty, such as physical inactivity, muscle weakness, anorexia, osteoporosis, and fatigue [4]. Frailty is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients, evidence on the frequency of frailty transition is scarce
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