Frailty is common in patients with chronic obstructive pulmonary disease (COPD) and is associated with reduced pulmonary function, exercise capacity, and quality of life, as well as increased long-term mortality, according to meta-analysis findings published in BMC Pulmonary Medicine.
Although patients with frailty and COPD are thought to be at risk of adverse COPD outcomes, the effect of frailty on outcomes is unclear. Researchers therefore conducted a systematic review and meta-analysis to quantify the impact of frailty on COPD health outcomes.
The researchers searched PubMed, Embase, the Cochrane Library, and Web of Science from January 1, 2002, to July 1, 2022, for studies that (1) involved adults with COPD who had a definite diagnosis of frailty and (2) provided comparative data between patients with COPD who did and did not have frailty. The researchers identified 20 articles involving 11,620 participants, including 10 observational cohort studies, 9 cross-sectional studies, and 1 randomized clinical trial.
Frailty prevalence, which was assessed by different tools in the various studies, ranged from 6.43% to 71.70%, with an overall prevalence of 32.07% (95% CI, 26.64-37.49). The pooled estimate value was 26.60% (95% CI, 20.37-34.74; P <.001; random-effects model), which did not affect the significance.
Patients living with COPD and frailty may benefit from some interventions such as pulmonary rehabilitation.
Based on data from 15 studies with 4122 participants, patients with frailty had poorer forced expiratory volume in the first second percent predicted (FEV1pp) than those without frailty (mean difference, -5.06%; 95% CI, -6.70 to -3.42%; I2 = 36.94%).
Data from 10 studies with 2392 participants regarding COPD Assessment Test (CAT) scores showed that patients with frailty had a higher CAT score vs those without frailty (mean difference, 6.20; 95% CI, 4.43-7.96; I2 = 84.95%). Meta-analysis of modified Medical Research Council (mMRC) grades from 9 studies revealed that having frailty was associated with an increased mMRC grade (mean difference, 0.93; 95% CI, 0.85-1.02; I2 = 0.00%).
The association between frailty status and 6-minute walking test (6MWT) was evaluated in 7 studies. Frailty was associated with shorter walking distance (mean difference -90.23 m; 95% CI, -124.70 to -55.76; I2 = 83.92%).
Activities of daily living (ADL) scores were reported in 4 studies with 2430 participants. The researchers found that having frailty was associated with poorer ADL (standardized mean difference, -0.99; 95% CI, -1.35 to -0.62; I2 = 86.74%).
The overall pooled analysis of 7 studies found a 1.68-fold increased risk of long-term all-cause mortality for patients with frailty (95% CI, 1.37-2.05; P <.0001) vs patients without frailty.
A major limitation of this meta-analysis is the studies’ use of different measures of frailty; inadequate and inconsistent definitions of frailty status may have affected the predictive value of frailty. Also, follow-up periods ranged from 90 days to 12 years, and the direct relationship between frailty and readmission and acute exacerbation could not be assessed, owing to a lack of data.
“Frailty is prevalent in people with COPD and negatively impacts clinical outcomes,” the investigators commented. “Assessment of the frailty status of patients with COPD can potentially guide clinical management of this population. Patients living with COPD and frailty may benefit from some interventions such as pulmonary rehabilitation.”