Frailty Is Common in Patients With COPD
Published 21 Jun 2016
The rate of frailty in patients with chronic obstructive pulmonary disease (COPD) referred for pulmonary rehabilitation is over twice that of the general population of older people, and these patients have a high risk for discontinuing the exercise therapy.
When researchers assessed the prevalence of frailty among 816 outpatients with COPD using the Fried criteria, they found that one in four (25%) were frail (95% CI 22.7-28.7), even though the mean age of the patients was just 70.
Compared with patients who were not frail, more than twice as many who were did not complete pulmonary rehabilitation programs, but those who did had improvements in key outcomes related to quality of life and disease burden, Matthew Maddocks, PhD, of Kings College London, and colleagues wrote online in Thorax.
"Our findings underscore a need to explore how better to support patients who are frail through rehabilitation programs, both because this group has the most difficulty engaging in current clinical services and because if they can engage, they should benefit a great deal," Maddocks told MedPage Today.
He added that pulmonary rehabilitation exercise programs tailored to frail patients with COPD would help more people access the treatment.
Patients were recruited from respiratory outpatient and pulmonary rehabilitation clinics at Harefield Hospital in Middlesex, U.K. The mean FEV1% predicted was 48.9 (21.0) at recruitment among the 816 study participants, who all entered the study between late 2011 and early 2015.
Fried criteria (weight loss, exhaustion, low physical activity, slowness, and weakness) was used to assess frailty before and after pulmonary rehabilitation, and predictors of program non-compliance were identified using multivariate logistic regression. Outcomes were compared using analysis of co-variance, adjusted for age and sex.
The prevalence of frailty increased with age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) score, and age-adjusted comorbidity burden.
Frailty was associated with double the odds of noncompletion of the program (adjusted OR 2.20, 95% CI 1.39 to 3.46), often due to exacerbation and/or hospital admission. Rehabilitation outcomes favored the frail completers, with consistently better responses in MRC score, exercise performance, physical activity level, and health status.
While frailty was more common in patients with spirometrically advanced disease, one in five patients with GOLD 1 category COPD were frail -- "emphasizing the importance of multidimensional assessment, even in early disease," the researchers wrote.
Following rehabilitation, significant improvements were seen among all groups for key measures of COPD including dyspnea and fatigue. Outcomes related to frailty, such as handgrip strength and physical activity, also improved.
After rehabilitation, 71 of 115 (61.3%) previously frail patients no longer met the case criteria for frailty. A total of 64 of these patients (55.6%) were reclassified as "pre-frail," and seven (6.1%) were reclassified as "robust."
Assessment of frailty using the Fried model, which is partially reliant on patient recall, was noted by the researchers as a potential study limitation.
While frailty is traditionally associated with old age, the presence of a chronic disease such as COPD can accelerate the rate of decline, study co-author William Man, PhD, FRCP, of Imperial College London told MedPage Today.
"Frailty is common in COPD and is associated with poor outcomes," he said. "In this study it was demonstrated by the significantly increased odds of failing to complete pulmonary rehabilitation, which is a cornerstone of COPD management."
He added that the findings also highlight the benefits of pulmonary rehabilitation for frail patients.
"The other very positive news is that clinicians don't need to be too nihilistic about frailty, as our study shows that this can be reversed even with non-pharmacological interventions like pulmonary rehabilitation," he said.
Maddocks noted that the frail patients included in the study had difficulty walking at recruitment, covering, on average, just over 100 meters during a 6-minute walk test. Almost half of the frail patients also had substantial leg muscle weakness and needed help with everyday activities.
"Our findings demonstrate that these people benefit just as much, if not more, than others who were not as frail," he said.
Facebook
Twitter2 comments
So these people like me need support when standing and then walking upright,so the other exercise would not be suitable ,yes I did them at the time,but to be upright is far more important to me now I will carry on walking upright is the best exercise for Frailty!!??
Common sense .... Not always seen by medical...... I am a real person explaining to you what people need to know. As I suffered far too long with limited minds and no help. so please listen and you will learn from real life people. A good walker with support. Not cheap British ones ,good design .sweedish or German .
You will also like
See the testimonial