Frailty: A global measure of the multisystem impact of COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is a multisystem disease that resembles the accumulation of multiple impairments seen in aging. A comprehensive geriatric assessment (CGA) captures multisystem deficits, from which a frailty index (FI) can be derived. We hypothesized that patients with COPD would be frailer than a comparator group free from respiratory disease. In this cross-sectional analysis, the CGA questionnaire was completed and used to derive an FI in 520 patients diagnosed with COPD and 150 comparators. All subjects were assessed for lung function, body composition, 6-minute walking distance (6MWD), and handgrip strength. Patients completed validated questionnaires on health-related quality of life and respiratory symptoms. Patients and comparators were similar in age, gender, and body mass index, but patients had a greater mean ± SD FI 0.16 ± 0.08 than comparators 0.05 ± 0.03. In patients, a stepwise linear regression 6MWD (β = −0.43), number of comorbidities (β = −0.38), handgrip (β = −0.11), and number of exacerbations (β = 0.11) were predictors of frailty (all p < 0.01). This large study suggests patients with COPD are frailer than comparators. The FI derived from the CGA captures the deterioration of multiple systems in COPD and provides an overview of impairments, which may identify individuals at increased risk of morbidity and mortality in COPD.

Handgrip Strength in Preoperative Elective Cardiac Surgery Patients and Association With Body Composition and Surgical Risk

“…Median HGS was significantly different between the low, medium, and high EuroSCORE operative risk scores (20 positive correlations between the BIA body composition parameters fat-free mass (FFM), body cell mass (BCM), and fat mass (FM) ( Table 4).…”

“…14,18 HGS is strongly recommended, since it is a simple, quick, inexpensive, noninvasive, and easily accessible method. This highly sensitive test allows for early detection of strength loss and protein depletion and is a useful method for nutrition diagnosis and monitoring, 15,17,18 with broader applicability as a component in the determination of frailty 14,20,21 and as a prognostic index 22,23 for several clinical situations.…”

Physical frailty characteristics have a differential impact on symptoms as measured by the CAT score: an observational study

“…Thus, it is possible that the differences between the prevalence reported in Maddocks’ study and our study were due to the physical or social characteristics of the two patient populations. On the other hand, a previous study also found a higher prevalence of frailty [ 11 , 29 ], but this result is not directly comparable because they used another framework or model of frailty. Moreover, Park’s study [ 11 ] should be considered with caution because patients were included based on COPD symptoms and not on the results of a post-bronchodilator spirometry, as recommended by the GOLD guidelines.…”

Frailty, Comorbidity, and COPD

“…Not surprisingly, many of these persons had some functional disability. Patients with COPD are more likely to be frail than other patients (8). A meta-analysis found that patients with COPD were twice as likely to be frail (9).…”