Is it possible to reverse frailty in patients with chronic obstructive pulmonary disease?

Frailty and Exacerbation of Chronic Obstructive Pulmonary Disease: Is There Any Association?

Purpose

This study investigated if individuals with chronic obstructive pulmonary disease (COPD) and frailty are more likely to have acute exacerbations of COPD or require hospitalization for exacerbation than those without frailty.

Patients and Methods

Data on 135 outpatients with stable COPD were analyzed with the Cox proportional hazards model to assess the risk of future events. The Kihon Checklist was administered at baseline to classify the participants as robust, pre-frail, or frail. The follow-up period was a maximum of six and a half years.

Results

In all, 76 patients (56.3%) experienced an exacerbation and 46 (34.1%) were hospitalized due to it. Multivariate Cox proportional hazards analysis that accounted for FEV1 and sex showed that the frail group was more likely to face future risks of COPD exacerbations [Hazard ratio 1.762 (95% CI 1.011-3.070), p=0.046] and hospitalizations for exacerbation [2.238 (1.073-4.667), p=0.032] than the robust group. No significant differences were observed when comparing robust patients to those who were pre-frail or pre-frail to frail either in exacerbations or hospitalizations. When comparing the C-indices for frailty and FEV1, the former index (exacerbation 0.591 and hospitalization 0.663) did not exceed the latter (0.663 and 0.769) in either analysis.

Conclusion

Frail COPD patients have a more unfavorable future risk of acute exacerbations of COPD and hospitalizations for exacerbation than robust patients. However, no significant differences were observed when comparing robust patients to those who were pre-frail or pre-frail to frail, suggesting that the future risk for COPD patients with frailty is only higher compared to those who are considered robust. Additionally, FEV1 was found to be a more reliable predictor of future events than measures of frailty.

Prevalence and risk factors of frailty in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis

OBJECTIVE

To systematically review the prevalence and risk factors for frailty in patients with chronic obstructive pulmonary disease (COPD).

METHODS

A systematic review and meta-analysis were conducted, and a search of the PubMed, Embase and Web of Science databases was carried out to collect Chinese and English studies on frailty and COPD published up to September 5, 2022.

RESULTS

A total of 38 articles were included for the quantitative analysis after the collected literature was either included or omitted based on pertinent criteria. The results indicated that the estimated overall pooled prevalence of frailty was 36% (95% confidence interval [CI] = 31-41%), and the estimated pre-frailty was 43% (95% CI = 37-49%). A higher age (odds ratio [OR] = 1.04; 95% CI = 1.01-1.06) and higher COPD assessment test (CAT) score (OR = 1.19; 95% CI = 1.12-1.27) were associated with a significantly increased likelihood of frailty in patients with COPD. However, a higher educational attainment (OR = 0.55; 95% CI = 0.43-0.69) and higher income (OR = 0.63; 95% CI = 0.45-0.88) were associated with a significantly reduced risk of frailty in patients with COPD. A total of 17 other risk factors for frailty were identified via qualitative synthesis.

CONCLUSION

The incidence of frailty in patients with COPD is high, and there are many influencing factors.

European Respiratory Society statement on frailty in adults with chronic lung disease

Frailty is a complex, multidimensional syndrome characterised by a loss of physiological reserves that increases a person's susceptibility to adverse health outcomes. Most knowledge regarding frailty originates from geriatric medicine; however, awareness of its importance as a treatable trait for people with chronic respiratory disease (including asthma, COPD and interstitial lung disease) is emerging. A clearer understanding of frailty and its impact in chronic respiratory disease is a prerequisite to optimise clinical management in the future. This unmet need underpins the rationale for undertaking the present work. This European Respiratory Society statement synthesises current evidence and clinical insights from international experts and people affected by chronic respiratory conditions regarding frailty in adults with chronic respiratory disease. The scope includes coverage of frailty within international respiratory guidelines, prevalence and risk factors, review of clinical management options (including comprehensive geriatric care, rehabilitation, nutrition, pharmacological and psychological therapies) and identification of evidence gaps to inform future priority areas of research. Frailty is underrepresented in international respiratory guidelines, despite being common and related to increased hospitalisation and mortality. Validated screening instruments can detect frailty to prompt comprehensive assessment and personalised clinical management. Clinical trials targeting people with chronic respiratory disease and frailty are needed.

Association of Prefrailty and Frailty With All-Cause Mortality, Acute Exacerbation, and Hospitalization in Patients With Chronic Obstructive Pulmonary Disease: A Meta-Analysis

OBJECTIVE

To evaluate the impact of prefrailty and frailty on all-cause mortality, acute exacerbation, and all-cause hospitalization in patients with chronic obstructive pulmonary disease (COPD).

DESIGN

Meta-analysis.

SETTING AND PARTICIPANTS

Two authors independently searched PubMed, Web of Science, and Embase databases until December 27, 2022，to identify studies that reported the predictive value of prefrailty and frailty in COPD patients.

MEASUREMENTS

All-cause mortality, acute exacerbation, and all-cause hospitalization.

RESULTS

Ten studies reporting on 11 articles enrolling 13,203 patients with COPD were included. The prevalence of frailty ranged from 6.0% to 51%. When compared with nonfrailty, the pooled adjusted hazard ratio (HR) of all-cause mortality was 1.48 (95% CI 0.92-2.40) for prefrailty and 2.64 (95% CI 1.74-4.02) for frailty, respectively. The pooled adjusted odds ratio (OR) of all-cause hospitalization was 1.35 (95% CI 1.05-1.74) for prefrailty and 1.65 (95% CI 1.05-2.61) for frailty. In addition, frailty significantly predicted all acute exacerbation (OR 2.20, 95% CI 1.26-3.81) but not moderate to severe acute exacerbation (OR 1.42, 95% CI 0.94-2.17) in patients with stable COPD. However, the pooled results of all-cause hospitalization were not reliable in leave-1-out sensitivity analyses.

CONCLUSIONS AND IMPLICATIONS

Frailty significantly predicts all-cause mortality in patients with COPD, even after adjustment for common confounding factors. Assessment of frail status in COPD patients may improve secondary prevention and allow early intervention. However, future studies are warranted to validate the impact of frailty defined by a standardized definition of frailty on acute exacerbation and all-cause hospitalization.

Is Frailty Diagnosis Important in Patients with COPD? A Narrative Review of the Literature

Frailty is prevalent in older adults and is related to a worsening functionality, quality of life, and health outcomes. Though there is an increasing interest in this field, the relationship between frailty and worsening COPD outcomes remains unknown. A narrative review of the literature with studies published between 2018 and 2022 was carried out to address three questions: the prevalence of frailty and other geriatric syndromes in COPD patients, the link between frailty and worsening health outcomes in COPD patients, and the non-pharmacological interventions performed in order to reverse frailty in these patients. A total of 25 articles were selected. Frailty prevalence ranged from 6% and 85.9%, depending on the COPD severity and the frailty measurement tool used. Frailty in COPD patients was related to a high prevalence of geriatric syndromes and to a high incidence of adverse events such as exacerbations, admissions, readmissions, and mortality. One study showed improvements in functionality after physical intervention. In conclusion, the prevalence of frailty is associated with a high incidence of geriatric syndromes and adverse events in COPD patients. The use of frailty screenings and a comprehensive geriatric assessment of COPD patients is advisable in order to detect associated problems and to establish individualized approaches for better outcomes.

Frailty and rehabilitation outcome in older patients with cardiorespiratory disease: preliminary multidimensional data

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are two clinical conditions often associated with cognitive dysfunctions, psychological distress, poor quality of life (QoL), and functional worsening. In addition, since patients suffering from these conditions are often older adults, frailty syndrome represents a further and important issue to be investigated. The present preliminary study aimed to perform a multidimensional assessment of CHF and/or COPD older patients (age ≥65) undergoing cardiac or pulmonary rehabilitation. The characteristics of the included patients (30 CHF and 30 COPD) resulted almost similar, except for the COPD patients' longer duration of illness and better performances in Addenbrooke's cognitive examination III subtests and short physical performance battery (SPPB). No significant differences were found in the frailty evaluation, but a consistent number of patients resulted to be frail (CHF=36.7% vs COPD=26.6%). After the rehabilitation program, a significant improvement was found in the whole sample concerning the executive functions (14.34±2.49 vs 15.62±2.22, p=0.001), quality of life (58.77±18.87 vs 65.82±18.45, p=0.003), depressive and anxious symptoms (6.27±4.21 vs 3.77±3.39, p=0.001 and 5.17±3.40 vs 3.38±3.21, p=0.001), frailty status [4.00 (3.00,5.00) vs 3.00 (3.00,5.00) p=0.035] and functional exercise abilities [SPPB, 7.40±3.10 vs 9.51±3.67, p=0.0002; timed up and go test, 14.62±4.90 vs 11.97±4.51, p<0.0001; 6-minute walking test, 353.85±127.62 vs 392.59±123.14, p=0.0002]. Preliminary results showed a substantial homogeneity of CHF and COPD older patients' cognitive, psychosocial, frailty, and functional characteristics. Nevertheless, the specific rehabilitation intervention appears promising in both clinical populations. This trial has been registered with the ClinicalTrials.gov, NCT05230927 registration number (clinicaltrials.gov/ct2/show/NCT05230927).

Ninjin’yoeito ameliorated PPE-induced pulmonary emphysema and anxiety/depressive-like behavior in aged C57BL/6J mice

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in the elderly. COPD is a chronic respiratory disease characterized by airway remodeling and alveolar emphysema. COPD patients are also at high risk for mental illnesses such as depression and anxiety. Ninjin’yoeito (NYT) is prescribed to patients with conditions such as post-illness and postoperative weakness, fatigue, poor appetite, skin rash, cold hands and feet, and anemia. In addition to traditional uses, NYT is also prescribed as a therapeutic drug for poor functioning of the digestive organs, respiratory organs, and urinary organs. NYT is also known to have an antioxidant effect. The objective of this study was to investigate whether NYT could ameliorate COPD-induced lung injury and anxiety/depression in aged C57BL/6J mice exposed to porcine pancreatic elastase (PPE). While intratracheal administration of PPE induced emphysema in elderly mice, long-term administration of NYT suppressed the pathology. NYT was also found to suppress the apoptosis and oxidative stress caused by PPE. In addition, long-term administration of NYT was found to ameliorate PPE-induced depressive-like behavior in three different behavioral studies. These results suggest that NYT has a therapeutic effect on emphysema and the behavioral abnormalities caused by PPE.

Association of geriatric syndromes in older adults with chronic obstructive pulmonary disease

Background

Geriatric syndromes (GS) are multi‐factorial conditions that make older adults vulnerable to morbidities and poor outcomes. The main objective was to observe the frequency of GS in older patients with COPD.

Methods

A case‐control study was conducted in the Geriatric department of a tertiary care hospital in India to evaluate geriatric syndromes including falls, cognitive impairment, frailty, functional impairment, urinary incontinence, malnutrition, and depression in patients with COPD and controls without COPD. The factors having a significant association with the occurrence of these GS in COPD patients were observed.

Results

In this study, 150 cases and 150 controls were included. The mean age of the participant was 65.85±5.54, with 76% males. Functional impairment, cognitive impairment, frailty, urinary incontinence, and malnutrition were significantly higher in COPD patients. The independent variables which increased the odds of geriatric syndromes were dyspnoea (≥2 mMRC grade) (AOR:3.54,95% CI:1.06‐11.8) and low socioeconomic status (AOR: 4.14, 95% CI: 1.03‐16.54), while male gender showed inverse association (AOR: 0.08,95% CI: 0.01‐0.99).

Conclusion

Geriatric syndromes are common in older COPD patients, and assessment for them should be done routinely in these patients.