Physical Frailty in COPD Patients with Chronic Respiratory Failure

Abstract

Background:The prevalence of physical frailty and its clinical characteristics in advanced chronic obstructive pulmonary disease (COPD) is unknown, as well as the usefulness of functional capacity tests to screen for physical frailty. The aim of the study was to evaluate the proportion and clinical portrait of COPD patients with chronic respiratory failure exhibiting physical frailty at the time of referral to home-based pulmonary rehabilitation. We also evaluate the usefulness of the short physical performance battery (SPPB) and timedup and go (TUG) as potential screening tools for physical frailty. Finally, we evaluated the specific contribution of gait speed to the frailty Fried total score. Methods: This was a prospective observational study in which physical frailty was defined using Fried criteria (body mass loss, exhaustion, low physical activity, slower walking and weakness). Clinical portrait was documented from daily physical activity, exercise tolerance, functional capacity, anxiety and depressive symptoms, health-related quality of life, and fatigue scores. The ability of the SPPB and TUG to predict physical frailty was investigated using receiver operating characteristic curves. Contribution of each Fried criteria was evaluated with a principal component analysis (PCA). Results: Amongst the 44 included participants (FEV 1 , 33 ± 13% of predicted), 19 were physically frail. Frail individuals had lower daily steps number, exercise tolerance and functional capacity, and higher fatigue, anxiety, and depressive symptom scores (p<0.05) compared to non-frail individuals. SPPB and TUG did not have an acceptable detection accuracy for screening physical frailty. PCA indicated that gait speed was the main contributor to the Fried total score of physical frailty. Conclusion: Physical frailty affects a large proportion of COPD patients with chronic respiratory failure starting a home-based intervention and was associated with worse clinical status. Although the present results need to be confirmed by adequately powered studies, gait speed seems to have the potential to become a simple screening tool for physical frailty in this population.

Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis

“…For frailty evaluation, 10 studies [ 10 , 11 , 13 , 23 – 25 , 29 – 32 ](50%) used the criteria of FFP; frailty was also measured by using other measurements, such as the Timed “Up and Go”(TUG) test [ 22 ](1, 5%) the comprehensive geriatric assessment (CGA) [ 26 ](1, 5%), frailty index [ 26 , 30 , 33 ](3, 15%), Frailty Staging System [ 34 ](1,5%), the Kihon Checklist [ 27 , 28 ](2,10%), FRAIL Scale [ 35 ](1,5%), the Reported Edmonton Frailty Scale(REFS) [ 14 ](1,5%) and HFRS [ 12 ](1,5%). One study used six criteria including weight loss, physical activity, mobility, hearing, strength for physical frailty, and anxiety/depression to assess frailty [ 36 ].…”

Prevalence and clinical impact of frailty in COPD：A Systematic Review and Meta-analysis

“…Seven studies evaluated the association between frailty status and 6-minute waking test 13,18,20,21,[25][26][27] .…”

Functional clinical impairments and frailty in interstitial lung disease patients

“…Multiple tests were designed to characterise exercise tolerance and functional capacity of ILD patients. The 6-min walk test (6MWT) is currently the gold standard for the evaluation of exercise tolerance due to its mortality prediction [ 3 ], but other tests such as the 1-min sit-to-stand (1STS) test and Short Physical Performance Battery (SPPB) have been studied with increasing interest in recent years [ 8 – 10 ].…”