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.

Keywords: Aging; COPD; comorbidities; frailty; systemic.

Figure 1.

Mean frailty index (FI) and percentage of frail patients classified by (a) age categories, (b) Medical Research Council (MRC) dyspnea score, (c) Global initiative for chronic Obstructive Lung Disease (GOLD) 1–4, and (d) GOLD A–D (using the CAT score).