Analyzing Changes in Frailty Among Patients With COPD

Frailty is present in about one-third of patients with chronic obstructive pulmonary disease (COPD), and the condition can significantly change clinical outcomes, according to study results published in PLOS One.

Investigators from Spain studied 119 patients with COPD for 2 years in order to determine their clinical outcomes and predictors of improvement in frailty status. Frailty is a known common condition among patients with COPD, but the study authors said evidence on the exact frequency is limited.

The patients included in the analysis were between 40 and 80 years old and assessed by a pulmonary physician at baseline. The examinations continued annually for the 2-year period.

To assess frailty, the study authors used 5 criteria based on Frield’s phenotype:

1. Unintentional weight loss
2. Low physical activity
3. Exhaustion
4. Slow walking speed
5. Low grip strength

Patients who met 3 or more of these criteria were considered frail; 1 or 2, pre-frail; and none, nonfrail.

The study authors also categorized frailty into 3 groups:

1. No change meant that patients maintained the same status after 2 years of follow-up.
2. Improvement was assigned to patients whose status changed from pre- to nonfrail.
3. Worsening patients transitioned either from non- to pre-frail or pre-frail to frail.

After 2 years, 21 patients improved their frailty status. Of those, 17 went from pre- to nonfrail and 4 from frail to pre-frail, the study authors reported. Fourteen patients worsened: 5 went from pre-frail to frail, 7 from non- to pre-frail, and 2 from nonfrail to frail during the study period. There were 84 patients whose frailty status did not change, the study authors said.

The investigators determined that about 40% of each of the nonfrail and frail patients demonstrated change, while only about 25% of the pre-frail group saw a change in their initial status.

The only clinical outcomes that appeared to change were physical activity levels and COPD Assessment Test scores, although there were no significant differences at baseline between the groups, the study authors said. The worsening group showed greater mean change and worsening of dyspnea, disability, and handgrip strength, they added. Furthermore, compared to the worsening group, the improvement group showed greater handgrip strength, quadricep strength, physical activity, and lower disability.

“Regarding the subgroup analysis, our improvement rate for ‘frail patients’ was lower than that reported for COPD patients in a pulmonary rehabilitation setting (61% vs 43%, respectively),” the study authors wrote. “This is expected because these programs are highly effective at improving many components of frailty, including slowness, fatigue, weakness, and physical activity. In addition, some programs include other frailty-related outcomes, such as balance training.”

The study authors suggested their findings are relevant for healthcare policymakers and professionals who manage frailty in patients with COPD, especially because the findings seem to indicate there is a window for successful interventions to reduce or improve frailty status.

“Multidisciplinary programs that include exercise, nutritional support, self-management strategies, and reduction polypharmacy, such as pulmonary rehabilitation, have been shown to be effective in reducing frailty,” they concluded.

Reference

Bernabeu-Mora R, Oliveira-Sousa SL, Sánchez-Martínez P, et al. Frailty transitions and associated clinical outcomes in patients with stable COPD: A longitudinal study [pulished online April 3, 2020]. PLOS One. doi: 10.1371/journal.pone.0230116.