Background

Physical frailty commonly is associated with COPD, and its evaluation in COPD may provide important prognostic information for risk stratification.

Research Questions

What are the comorbid associations of physical frailty with COPD? Does physical frailty singly and in combination with FEV₁ percent predicted and dyspnea predict disability and mortality?

Study Design and Methods

Prospective cohort study of community-dwelling adults 55 years of age or older in the Singapore Longitudinal Ageing Study. Baseline data of 1,162 participants with COPD and 3,465 participants without COPD included physical frailty, FEV₁ percent predicted, and dyspnea. Outcome measures were prevalent and incident instrumental activities of daily living (IADL) and basic activities of daily living (ADL) disability at 3 to 5 years of follow-up and all-cause mortality up to 11 years. ORs, hazard ratios, and 95% CIs were adjusted for socioeconomic status, smoking, and comorbidity count.

Results

Baseline prevalence of prefrailty (48.8%) and frailty (6.8%) in participants with COPD were significantly higher than in participants without COPD: frailty OR, 1.61; 95% CI, 1.15-2.26. Prefrailty or frailty was associated significantly with twofold increased odds of prevalent and incident IADL and basic ADL disability and mortality in participants with COPD. In combination with FEV₁ percent predicted of < 80% or dyspnea, frailty was associated with substantially increased threefold to fourfold odds of prevalent and incident IADL and basic ADL disability, and twofold to threefold increased mortality hazard. A summary score combining physical frailty, FEV₁ of < 80%, and dyspnea predicted steeper risk gradients of prevalent and incident IADL and basic ADL disability and mortality across four risk categories (0, 1, 2, 3-5), with the highest risk category predicting between sevenfold and 8.5-fold increased risks in crude analyses, which remained significantly high after covariate adjustment.

Interpretation

The study supports the use of physical frailty in addition to lung function and dyspnea in multidimensional evaluation of COPD.

中文翻译：

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身体虚弱和慢性阻塞性肺病的同时发生以及与残疾和死亡率的关联

背景

身体虚弱通常与 COPD 相关，其在 COPD 中的评估可能为风险分层提供重要的预后信息。

研究问题

身体虚弱与 COPD 有哪些共病关联？身体虚弱是否单独以及与 FEV ₁ % 预测和呼吸困难相结合可以预测残疾和死亡率？

研究设计和方法

新加坡纵向老龄化研究中 55 岁或以上的社区居民的前瞻性队列研究。1,162 名 COPD 参与者和 3,465 名非 COPD 参与者的基线数据包括身体虚弱、FEV ₁ % 预测值和呼吸困难。结果测量是在 3 至 5 年的随访和长达 11 年的全因死亡率中的普遍和偶然的日常生活工具活动 (IADL) 和基本日常生活活动 (ADL) 残疾。ORs、风险比和 95% CI 已根据社会经济状况、吸烟和合并症计数进行了调整。

结果

COPD 参与者的早期衰弱 (48.8%) 和衰弱 (6.8%) 的基线患病率显着高于非 COPD 参与者：衰弱 OR，1.61；95% CI，1.15-2.26。早衰或衰弱与 COPD 参与者的普遍和事件 IADL 和基本 ADL 残疾和死亡率增加两倍的几率显着相关。结合预测的 FEV ₁ % < 80% 或呼吸困难，虚弱与普遍和事件 IADL 和基本 ADL 残疾的几率显着增加三至四倍有关，死亡风险增加两倍至三倍。结合身体虚弱的综合评分，FEV ₁< 80%，并且呼吸困难预测了四个风险类别（0、1、2、3-5）中普遍和事件 IADL 和基本 ADL 残疾和死亡率的更陡峭的风险梯度，最高风险类别预测在 7 倍和 8.5 倍之间原油分析的风险增加，在协变量调整后仍然很高。

解释

该研究支持在对 COPD 进行多维评估时，除了肺功能和呼吸困难外，还使用身体虚弱。