European Respiratory Society statement on frailty in adults with chronic lung disease

Osadnik, Christian; Brighton, Lisa Jane; Burtin, Chris; Cesari, Matteo; Lahousse, Lies; Man, William D.-C.; Marengoni, Alessandra; Sajnic, Andreja; Singer, Jonathan P.; Beek, Lies ter; Tsiligianni, Ioanna; Varga, János; Pavanello, Stefano; Maddocks, Matthew

doi:10.1183/13993003.00442-2023

Cited by 20 publications

(4 citation statements)

References 182 publications

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“…In addition, lung function impairment is often associated with excessive oxidative stress and systemic inflammation, such as elevated levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP), which has been implicated in the pathogenesis of frailty [ 37 , 38 ]. Moreover, healthy lung function indicates optimized tissue oxygenation, which is essential for preserving muscle mass and function and may lessen frailty [ 39 , 40 ]. These factors may interact in complex ways to mediate the impact of lung function on frailty.…”

Section: Discussionmentioning

confidence: 99%

Lung function and the risk of frailty in the European population: a mendelian randomization study

Zhou,

Tian,

Guo

et al. 2024

Eur J Med Res

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Background Epidemiological evidence has suggested a relationship between lung function and frailty, but the precise nature of the causality remains unclear. In this study, we applied a two-sample Mendelian randomization (MR) analysis to determine the causal effects of lung function on frailty. Methods Single nucleotide polymorphisms (SNPs) independently related (P ≤ 5E−08) to lung function, as identified by genome-wide association study (GWAS), were applied as instrumental variables (IV). The association with frailty index (FI) was investigated using summary-level data from the latest GWAS on FI (n = 175,226). Different statistical methods were employed to evaluate the causal estimates between lung function and FI. The pleiotropy, heterogeneity, and leave-one-out analysis were applied to confirm the stability of the MR estimates. Results Using the random-effect inverse-variance weighted approach, genetically proxied forced expiratory volume in the first second (FEV1), ratio of FEV1 on forced vital capacity (FVC) [FEV1/FVC], and peak expiratory flow (PEF) were significantly and inversely associated with FI (FEV1, β = −0.08, P = 2.03E−05; FEV1/FVC, β = −0.06, P = 9.51E−06; PEF, β = −0.07, P = 4.09E−04) with good statistical power (99.7–100%). However, no significant association was observed between FVC and FI (β = −0.01, P = 0.681). Leave-one-out analysis showed that there was no single SNP driving the bias of the estimates. There was potential heterogeneity, but no obvious pleiotropy was founded in this MR study. Conclusions Our findings indicate that impaired pulmonary function is closely related to the risk of frailty. Enhancing lung function in the elderly population may contribute to the prevention of frailty to a certain extent.

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Section: Discussionmentioning

confidence: 99%

Lung function and the risk of frailty in the European population: a mendelian randomization study

Zhou,

Tian,

Guo

et al. 2024

Eur J Med Res

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“…The exact mechanism behind this difference has yet to be identified, but it is speculated that frail COPD patients may experience progressive muscle weakness, reduced physical activity, social isolation, and deteriorating health, all of which could contribute to an increased risk of acute exacerbations. 46 These exacerbations are often triggered by factors such as respiratory infections, and it is possible that frail COPD patients are more susceptible to these triggers or have a lower threshold for experiencing exacerbations. Further research is needed to confirm this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Frailty and Exacerbation of Chronic Obstructive Pulmonary Disease: Is There Any Association?

Nishimura,

Kusunose,

Sanda

et al. 2024

COPD

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Purpose This study investigated if individuals with chronic obstructive pulmonary disease (COPD) and frailty are more likely to have acute exacerbations of COPD or require hospitalization for exacerbation than those without frailty. Patients and Methods Data on 135 outpatients with stable COPD were analyzed with the Cox proportional hazards model to assess the risk of future events. The Kihon Checklist was administered at baseline to classify the participants as robust, pre-frail, or frail. The follow-up period was a maximum of six and a half years. Results In all, 76 patients (56.3%) experienced an exacerbation and 46 (34.1%) were hospitalized due to it. Multivariate Cox proportional hazards analysis that accounted for FEV 1 and sex showed that the frail group was more likely to face future risks of COPD exacerbations [Hazard ratio 1.762 (95% CI 1.011–3.070), p=0.046] and hospitalizations for exacerbation [2.238 (1.073–4.667), p=0.032] than the robust group. No significant differences were observed when comparing robust patients to those who were pre-frail or pre-frail to frail either in exacerbations or hospitalizations. When comparing the C-indices for frailty and FEV 1 , the former index (exacerbation 0.591 and hospitalization 0.663) did not exceed the latter (0.663 and 0.769) in either analysis. Conclusion Frail COPD patients have a more unfavorable future risk of acute exacerbations of COPD and hospitalizations for exacerbation than robust patients. However, no significant differences were observed when comparing robust patients to those who were pre-frail or pre-frail to frail, suggesting that the future risk for COPD patients with frailty is only higher compared to those who are considered robust. Additionally, FEV 1 was found to be a more reliable predictor of future events than measures of frailty.

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“…A Task Force of the European Respiratory Society (ERS) has recently published a report on frailty in chronic lung diseases, including COPD [26]. The report has highlighted that frailty assessment leads to a more personalised management of patients with COPD, covering different aspects such as nutrition and rehabilitation.…”

Section: Frailty In Copdmentioning

confidence: 99%

Impact of Frailty on Symptom Burden in Chronic Obstructive Pulmonary Disease

Verduri,

Clini,

Carter

et al. 2024

JCM

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Chronic obstructive pulmonary disease (COPD), the sixth leading cause of death in the United States in 2022 and the third leading cause of death in England and Wales in 2022, is associated with high symptom burden, particularly dyspnoea. Frailty is a complex clinical syndrome associated with an increased vulnerability to adverse health outcomes. The aim of this review was to explore the current evidence of the influence of frailty on symptoms in patients with a confirmed diagnosis of COPD according to GOLD guidelines. Fourteen studies report a positive association between frailty and symptoms, including dyspnoea, assessed with the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) scale. Data were analysed in a pooled a random-effects meta-analysis of mean differences (MDs). There was an association between COPD patients living with frailty and increased CAT score versus COPD patients without frailty [pooled SMD, 1.79 (95% CI 0.72–2.87); I2 = 99%]. A lower association was found between frailty and dyspnoea measured by the mMRC scale versus COPD patients without frailty [pooled SMD, 1.91 (95% CI 1.15–2.66); I2 = 98%]. The prevalence of frailty ranged from 8.8% to 82% and that of pre-frailty from 30.4% to 73.7% in people living with COPD. The available evidence supports the role of frailty in worsening symptom burden in COPD patients living with frailty. The review shows that frailty is common in patients with COPD. Future research is needed to have further details related to the data from CAT to improve our knowledge of the frailty impact in this population.

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European Respiratory Society statement on frailty in adults with chronic lung disease

Cited by 20 publications

References 182 publications

Lung function and the risk of frailty in the European population: a mendelian randomization study

Lung function and the risk of frailty in the European population: a mendelian randomization study

Frailty and Exacerbation of Chronic Obstructive Pulmonary Disease: Is There Any Association?

Impact of Frailty on Symptom Burden in Chronic Obstructive Pulmonary Disease

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