Patients with chronic obstructive pulmonary disease (COPD) who were classified as frail were more likely to have lower quality of life, increased rate and length of hospitalization, and a higher rate of mortality compared with non-frail patients, according to the results of a study published in the Annals of the American Thoracic Society .
Chronic Obstructive Pulmonary Disease
COPD is a type of obstructive lung disease characterized by long-term breathing problems and poor airflow. The main symptoms include shortness of breath and cough with sputum production. COPD is a progressive disease, meaning it typically worsens over time. Eventually everyday activities, such as walking or getting dressed, become difficult.
Chronic bronchitis and emphysema are older terms used for different types of COPD. The term "chronic bronchitis" is still used to define a productive cough that is present for at least three months each year for two years.
Tobacco smoking, including second-hand smoking, is the most common cause of COPD, with factors such as air pollution and genetics playing a smaller role. In the developing world, one of the common sources of air pollution is poorly vented heating and cooking fires. Long-term exposure to these irritants causes an inflammatory response in the lungs , resulting in narrowing of the small airways and breakdown of lung tissue.
Health outcomes were retrospectively analyzed from the National Emphysema Treatment Trial (NETT). Patients were classified in either the frail or non-frail group according to the frailty conceptual phenotype model. Frail patients were defined as having ≥3 parameters of frailty as body mass index decrease ≥5% over 12 months, self-reported exhaustion, low 6-minute walking distance scores, or physical activity or respiratory muscle strength in the lowest quartile.
Participants meeting less than 3 criteria were considered non-frail. Participants were followed for 2 years. Of the 902 study participants, the incidence rate of frailty was 6.4 per 100 person-years. Frail participants reported significantly worse disease-specific and overall quality of life, as measured by St. George's Respiratory Questionnaire (mean difference, 11.6; P <.001).
In addition, frail participants had an increased incidence of hospitalization (adjusted hazard ratio, 1.6; P = .02) and 8-day increase in hospital use ( P <.0001). Frail participants had a higher mortality rate (adjusted hazard ratio, 1.4, P = .07). "Further understanding of how the COPD frailty phenotype can be modified or treated and if modification improves hospitalization, mortality, and quality of life outcomes are key topics for future research," the conclusion concluded.