Frailty in asthma-COPD overlap: a cross-sectional study of association and risk factors in the NHANES database

Abstract

BackgroundAsthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a condition characterised by the simultaneous presence of features of both asthma and COPD. The study aims to investigate the association between ACO and frailty among middle-aged and elderly populations, and identify the risk factors for frailty in individuals with ACO.MethodsWe conducted a cross-sectional study with 34 403 eligible participants (aged ≥40 years) from the National Health and Nutrition Examination Survey 1999–2018 cycles. Participants were stratified into four groups: ACO, asthma, COPD and non-asthma/COPD. Frailty assessment was based on frailty index, generating frail and non-frail group. Univariate and multivariate survey-weighted logistic regression analysis were used to determine the association between ACO and frailty, and to identify the risk factors for frailty in ACO.ResultsThe frailty prevalence in participants with ACO was 60.2%, significantly higher than that in those with asthma (32.3%) and COPD (40.6%). In the unadjusted model, participants with ACO exhibited six-fold higher odds of frailty (OR 6.30, 95% CI 5.29 to 7.49), which was significantly greater than those with COPD (OR 2.84, 95% CI 2.46 to 3.28) and asthma (OR 1.99, 95% CI 1.80 to 2.18), using the non-asthma/COPD group as a reference. After adjusting for all confounders, participants with ACO had over four times higher odds of frailty (OR 4.48, 95% CI 3.53 to 5.71), still higher than those with asthma and COPD. The findings remained robust in sensitivity and subgroup analyses. Furthermore, hypertension, cancer, cardiovascular disease, chronic kidney disease and cognitive disorders were identified as risk factors for frailty among ACO participants, while higher income and education levels were protective factors.ConclusionPatients (aged ≥40 years) with ACO were at a higher risk of frailty, regardless of age or sex, compared with those with asthma or COPD alone. Greater attention should be paid to patients with ACO, regardless of their age.

Epidemiological characteristics of asthma-COPD overlap, its association with all-cause mortality, and the mediating role of depressive symptoms: evidence from NHANES 2005–2018

“…Our study revealed some epidemiological characteristics of people with ACO. Our findings resonated Wang et al (2023)’s [ 4 ] and Llanos et al (2018)’s [ 1 ] discoveries with the NHANES database, showing that the mean age of participants with ACO was lower than that of those with COPD-only but higher than that of individuals with asthma-only. While in this study the ACO group had a more similar demographic pattern with the COPD-only group than the asthma-only group and the non-asthma/COPD group, the ACO group was significantly different from the COPD-only group in terms of gender, race and BMI, as the ACO group had more individuals from non-White population, more female, and more with a higher BMI, like what was suggested in Alsayed et al (2023)’s [ 2 ] review.…”

“…It reported that the prevalence of ACO in the general population ranged from 2 to 3 percent. Our finding was higher than what was observed by some previous studies based on NHANES, e.g., around 1% in Mendy et al (2018) [ 26 ] with NHANES 2007–2012, 1.47% in Llanos et al (2018) with NHANES 2009–2012 [ 1 ] with NHANES 2009–2012, and 2.88% in Wang et al (2023) [ 4 ] with NHANES 1999–2018, which was probably due to the fact that our study included the data from the NHANES 2005–2018 that encompassed more recent years. This may suggest that the prevalence of ACO has increased in recent years.…”

“…By using the commonly used criteria of or available approaches to identifying the focused diseases and clinical conditions, and relying on the data availability within the NHANES 2005–2018, this study grouped participants as follows: 1) the asthma-only group ( N = 2352) [ 1 , 4 , 31 – 33 ], including participants who reported at least one of the following conditions: a) having an episode of asthma or an asthma attack during the past 12 months, b) ever being told by a doctor or other health professionals that they had asthma, and c) using drugs including selective phosphodiesterase-4 inhibitors, mast cell stabilisers, leukotriene modifiers or inhaled corticosteroids, and excluding participants with chronic bronchitis and emphysema; 2) the COPD-only group ( N = 853) [ 4 , 31 , 34 , 35 ], including participants who had at least one of the following conditions: a) reporting having emphysema, b) reporting ever being told they had emphysema, c) having a ratio of forced expiratory volume in 1 s (FEV1) and forceful lung volume (FVC) (FEV1/FVC) after bronchodilator use less than 0.70 in laboratory test, and d) reporting ever being told they had chronic bronchitis and used drugs including selective phosphodiesterase-4 inhibitors, mast cell stabilisers, leukotriene modifiers, inhaled corticosteroids, and excluding participants with asthma; 3) the ACO group ( N = 705) [ 4 , 6 , 36 , 37 ], including participants who met the identification criteria for both asthma and COPD (at least 1 characteristic from each); 4) the non-asthma/COPD group, including participants who did not meet any identification criteria for the asthma-only or COPD-only group. We formed the non-ACO group by combining participants from the asthma-only, COPD-only, and non-asthma/COPD groups.…”

“…They have unique clinical features requiring different management strategies but can coexist. Despite a lack of consensus on its recognition, definition, and diagnosis [ 2 , 3 ], the term "Asthma-COPD overlap" (ACO), describing a condition where individuals show symptoms of both asthma and COPD, has gained widespread use since it was recommended by the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2017 [ 2 , 4 , 5 ]. While the debate about the term is still ongoing, there is agreement among healthcare professionals that patients presenting symptoms of both Asthma and COPD require personalized care for better outcomes [ 3 , 6 ].…”

Developing and validating machine learning-based prediction models for frailty occurrence in those with chronic obstructive pulmonary disease

“…This study also revealed that frailty occurred more frequently in patients with COPD who had a variety of comorbidities. We also observed that patients with both COPD and asthma showed a higher risk of vulnerability, possibly due to the compounding effects of the two diseases ( 39 ). Vulnerability refers to an individual’s susceptibility to physical, psychological, and social stress.…”