Frailty and patient-reported outcomes in subjects with chronic obstructive pulmonary disease: are they independent entities?

Kusunose, Masaaki; Oga, Toru; Nakamura, Shigeaki; Hasegawa, Yoshinori; Nishimura, Koichi

doi:10.1136/bmjresp-2017-000196

Cited by 47 publications

(71 citation statements)

References 32 publications

(53 reference statements)

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“… 8 A recent study reported a prevalence of 21% frailty in patients with COPD using the Kihon Checklist. 11 These studies are lower than a UK population study where the reported prevalence of frailty was 57.8% in 70 COPD patients diagnosed on the basis of symptoms rather an objective measure of airways obstruction. 10 Unlike the latter study, our study population was unselected based on physician defined COPD with mandatory demonstration of airways obstruction at the time of entry to the ARCADE study 15 and hence provided a wider spectrum of disease severity and comorbidities which might account for the variation.…”

Section: Discussionmentioning

confidence: 72%

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Frailty: A global measure of the multisystem impact of COPD

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 72%

“… 8 A recent study reported 21% frailty in a Japanese COPD cohort. 11 In addition to various populations studied, there were differences in study design, methods to assess frailty, and lack of appropriate population controls. 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

Frailty: A global measure of the multisystem impact of COPD

et al. 2018

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“…Frailty appeared to have developed via an independent mechanism except for age-related deterioration in patients with COPD. Frailty assessment was recommended to be included as a part of multidimensional measurements of COPD 96. However, similar to FRAIL scale, further validation studies of the KCL in hospitalized COPD patients need to be undertaken.…”

Section: Kihon Checklist (Kcl)mentioning

confidence: 99%

Frailty assessment in older adults with chronic obstructive respiratory diseases

Guan¹,

Huang²

2018

CIA

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The number of patients with chronic obstructive pulmonary disease (COPD) has been rising with continued exposure to environmental risk factors and aging of populations around the world. Frailty is a geriatric syndrome with a decline in physiological reserve and often coexists with chronic diseases such as COPD. Frailty is an independent risk factor for the development and progression of COPD, and COPD can lead to frailty; treating one might improve the other. Thus, there is an increasing interest in the assessment of frailty in patients with COPD. Furthermore, early identification and assessment of frailty in patients with COPD may affect the choice of intervention and improve its effectiveness. Based on the current literature, the intent of this review was to summarize and discuss frailty assessment tools used for COPD patients and the relevant clinical practices for predicting outcomes. We ascertain that using suitable frailty assessment tools could facilitate physicians to screen and stratify physically frail patients with COPD. Screening appropriately targeted population can achieve better intervention outcomes and pulmonary rehabilitation among frail COPD patients.

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“…1,4 People with both COPD and frailty are at increased risk of mortality 5,6 and readmission within 3-months posthospitalisation for an exacerbation of their disease. 7,8 Compared to people who have COPD but no indication of frailty, they experience poorer physical function and health status, 9 and increased anxiety and depression symptoms. 10 People with COPD and frailty are also less likely to start and complete pulmonary rehabilitation, 10 and have lower levels of physical activity.…”

Section: Introductionmentioning

confidence: 99%

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

Brighton

Evans

Man

et al. 2020

COPD

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Background: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercisebased interventions might improve outcomes for people living with both COPD and frailty. Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour. Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent. Conclusion: Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.

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Frailty and patient-reported outcomes in subjects with chronic obstructive pulmonary disease: are they independent entities?

Cited by 47 publications

References 32 publications

Frailty: A global measure of the multisystem impact of COPD

Frailty: A global measure of the multisystem impact of COPD

Frailty assessment in older adults with chronic obstructive respiratory diseases

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

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