Determinants of frailty in primary care patients with COPD: the Greek UNLOCK study

Abstract

BackgroundFrailty is a state of increased vulnerability that has a significant risk of unfavorable outcomes such as increased dependency and/or death, but little is known about frailty in people with chronic obstructive pulmonary disease (COPD).MethodWe aimed to determine the prevalence of frailty in COPD patients and to identify the associated risk factors. Two hundred fifty-seven COPD patients enrolled from primary care in Greece between 2015 and 2016. Physicians used structured interviews to collect cross-sectional data including demographics, medical history, symptoms and COPD Assessment Tool (CAT) or modified Medical Research Council Dyspnea scale (mMRC) score. Patients were classified into severity groups according to GOLD 2017 guidelines. Participants completed the The Frail Non-Disabled (FiND) questionnaire, exploring the frailty and disability domains. In the present analyses, frail patients with and without mobility disability were pooled and were compared to non-frail patients. Factors associated with frailty were analyzed using univariate and multivariate logistic regression.ResultsMean (SD) age was 65 (12.3) with 79% males. The majority of patients suffered with frailty (82%) of which 76.8% had mobility disability. 84.2% were married/with partner and 55.4% retired. 55.6% were current smokers. Uncontrolled disease (≥10 CAT score) was reported in 91.1% and 37.2% of patients had ≥2 exacerbations in the past year. Dyspnea (38%) and cough (53.4%) were the main symptoms. Main comorbidities were hypertension (72.9%), hyperlipidaemia (24.6%) and diabetes (11%).Risk of frailty was significantly increased with age (OR; 95%CI: 1.05; 1.02–1.08), hypertension (2.25; 1.14–4.45), uncontrolled disease (≥10 CAT score 4.65; 1.86–11.63, ≥2 mMRC score 5.75 (2.79–11.85) or ≥ 2 exacerbations 1.73; 1.07–2.78), smoking cessation (ex compared to current smokers: 2.37; 1.10–5.28) and GOLD status (B&D compared to A&C groups: CAT-based 4.65; 1.86–11.63; mMRC-based: 5.75; 2.79–11.85). In multivariate regression smoking cessation and GOLD status remained significant. Gender, body mass index, occupational or marital status, symptoms and other comorbidities were not significant.ConclusionsFrailty with mobility disability is common in COPD patients and severity of disease increases the risk. It is possible that frail patients are more likely to quit smoking perhaps because of their disability and uncontolled disease. Routine assessment of frailty in addition to COPD control may allow early interventions for preventing or delaying progression of frailty and improvement in COPD disease.

Asthma is associated with frailty among community-dwelling adults: the GAZEL cohort

“…Moreover, old people with COPD and frailty had a poorer survival than any other combination of frailty and COPD 15. Frail patients with COPD also reported a poorer quality of life suggesting that their health situation considerably impairs their everyday life 16. To the best of our knowledge, only one study has reported a positive and significant association between asthma and frailty among other self-reported long-term conditions in middle-aged people 17.…”

Adherence to inhalers and comorbidities in COPD patients. A cross-sectional primary care study from Greece

“…The study was approved by the local medical ethics committee of the University Hospital of Crete Greece (protocol number 7985) and the patients gave written informed consent. Detailed methods have been previously published [26][27][28]. Subjects were recruited by 53 facilities with participants ranging between 5 and 20 patients per area.…”

Associations of sense of coherence and self-efficacy with health status and disease severity in COPD

“…A sample of 257 COPD patients, previously diagnosed by spirometry performed by chest physicians, was cross-sectionally enrolled between 2015 and 2016 from 53 primary care facilities in Greece. More details on the methodology are available in previous publications 38,39 . The study was approved by the local medical ethics committee of the University Hospital of Crete Greece (protocol number 7985), while all participants agreed to participate and provided written consent forms.…”

“…GPs performed structured interviews with the aim to collect cross-sectional information, including demographic characteristics, medical history, lifestyle, CAT 40 and mMRC 41 scores, annual number of exacerbations and hospitalizations due to respiratory illness and medication used for COPD management. Extended details on exacerbations, definitions, comorbidities and overall processes and standards are provided in previous study publications 38,39 . For measuring sense of coherence, we used the original SOC questionnaire developed by Antonovsky 12,42 , which was translated and validated into Greek 43 .…”