Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, particularly among older adults. Frailty, a condition characterized by reduced physiological resilience, is prevalent among patients with COPD, increasing their risk for complications such as infections, disability, and hospital readmissions. As COPD progresses, the cumulative effects of inflammation, physical inactivity, and comorbidities further predispose patients to frailty, significantly impacting their functional independence and overall QOL.
“Therefore, it is crucial to identify frailty early,” wrote Xiuyun Chen, MM, and colleagues in a recent paper published in Alternative Therapies, adding that their meta-analysis was intended to “provide healthcare professionals valuable information for early recognition and intervention measures.”
The authors reviewed 12 studies on frailty in patients with COPD, including both Chinese and English-language sources. They analyzed data from 6,860 participants, with 1,928 patients classified as frail.
Frailty Risk Factors
The overall incidence of frailty in patients with COPD was 26% (OR, 0.26; 95% CI, 0.17-0.34). Older age significantly increased the likelihood of frailty, and more severe COPD stages, as classified by GOLD pulmonary function, were associated with greater frailty risk.
Increased breathlessness, measured by the mMRC dyspnea score, was strongly linked to frailty. The presence of additional chronic conditions further raised the risk, as did polypharmacy, with the use of multiple medications being a major contributing factor. Malnutrition and depression were also linked to higher frailty rates.
Additionally, patients who had two or more hospital admissions within a year faced a significantly higher risk.
Addressing Frailty in Patients With COPD
“It is recommended that medical staff take measures to prevent frailty but also dynamically observe changes in patients’ conditions and strengthen continuous care. This approach can help prevent repeated admissions and reduce the risks for frailty during exacerbations,” the researchers wrote.
The researchers wrote that frailty contributes to a heightened risk for adverse health outcomes, including frequent COPD exacerbations, loss of mobility, and increased mortality. Early identification of high-risk patients through routine screening can facilitate timely interventions, such as pulmonary rehabilitation, nutritional support, and medication management.
Addressing polypharmacy and comorbidities is crucial in mitigating frailty-related complications, as excessive medication use may lead to side effects that further impair patient function. Implementing structured exercise programs, psychosocial support, and dietary modifications can help slow the progression of frailty and enhance overall well-being.
The researchers acknowledged several limitations, including the heterogeneity of included studies and the reliance on cross-sectional data. Differences in frailty assessment methods and population characteristics may have influenced reported prevalence rates. In addition, self-reported measures introduced potential bias, making it essential for future studies to incorporate objective functional assessments.
“Medical staff need to assess the frailty tendency of COPD from various perspectives, identify those at high risk for frailty early on, and implement individualized intervention measures for modifiable factors. This approach can help reduce the incidence of frailty in patients with COPD and enhance their long-term QOL,” the researchers concluded.
