Frailty in Chronic Obstructive Pulmonary Disease and Risk of Exacerbations and Hospitalizations

Abstract

Nathan Yee,1 Emily R Locke,2 Kenneth C Pike,3 Zijing Chen,3 Jungeun Lee,4 Joe C Huang,5 Huong Q Nguyen,6 Vincent S Fan2,7 1Department of Medicine, University of Washington, Seattle, WA, USA; 2Department of Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; 3Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA; 4College of Nursing, University of Rhode Island, Kingston, RI, USA; 5Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, WA, USA; 6Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; 7Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USACorrespondence: Vincent S FanDepartment of Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Pulmonary Section, S-111-Pulm, 1660 S. Columbian Way, Seattle, WA 98108, USATel [phone]Fax [phone]Email [email protected]: Frailty is a complex clinical syndrome associated with vulnerability to adverse health outcomes. While frailty is thought to be common in chronic obstructive pulmonary disease (COPD), the relationship between frailty and COPD-related outcomes such as risk of acute exacerbations of COPD (AE-COPD) and hospitalizations is unclear.Purpose: To examine the association between physical frailty and risk of acute exacerbations, hospitalizations, and mortality in patients with COPD.Methods: A longitudinal analysis of data from a cohort of 280 participants was performed. Baseline frailty measures included exhaustion, weakness, low activity, slowness, and undernutrition. Outcome measures included AE-COPD, hospitalizations, and mortality over 2 years. Negative binomial regression and Cox proportional hazard modeling were used.Results: Sixty-two percent of the study population met criteria for pre-frail and 23% were frail. In adjusted analyses, the frailty syndrome was not associated with COPD exacerbations. However, among the individual components of the frailty syndrome, weakness measured by handgrip strength was associated with increased risk of COPD exacerbations (IRR 1.46, 95% CI 1.09– 1.97). The frailty phenotype was not associated with all-cause hospitalizations but was associated with increased risk of non-COPD-related hospitalizations.Conclusion: This longitudinal cohort study shows that a high proportion of patients with COPD are pre-frail or frail. The frailty phenotype was associated with an increased risk of non-COPD hospitalizations but not with all-cause hospitalizations or COPD exacerbations. Among the individual frailty components, low handgrip strength was associated with increased risk of COPD exacerbations over a 2-year period. Measuring handgrip strength may identify COPD patients who could benefit from programs to reduce COPD exacerbations.Keywords: chronic obstructive pulmonary disease, frailty, weakness, handgrip strength

Keywords

• pulmonary disease
• chronic obstructive
• frailty
• weakness
• handgrip strength