Frailty, a Dimension of Impaired Functional Status in Advanced COPD: Utility and Clinical Applicability

Abstract

Background and Objectives: In advanced chronic obstructive pulmonary disease (COPD), functional status is significantly impaired mainly as a result of disease related respiratory symptoms such as dyspnea or as a result of fatigue, which is the extra-respiratory symptom the most prevalent in this setting. “Physical” frailty, considered to be an aging phenotype, has defining traits that can also be considered when studying impaired functional status, but little is known about this relationship in advanced COPD. This review discusses the relevance of this type of frailty in advanced COPD and evaluates it utility and its clinical applicability as a potential outcome measure in palliative care for COPD. Materials and Methods: A conceptual review on the functional status as an outcome measure of mortality and morbidity in COPD, and an update on the definition and traits of frailty. Results: Data on the prognostic role of frailty in COPD are rather limited, but individual data on traits of frailty demonstrating their relationship with mortality and morbidity in advanced COPD are available and supportive. Conclusions: Frailty assessment in COPD patients is becoming a relevant issue not only for its potential prognostic value for increased morbidity or for mortality, but also for its potential role as a measure of functional status in palliative care for advanced COPD.

Monthly Follow-Ups of Functional Status in People with COPD: A Longitudinal Study

“…Moreover, a causal relationship could not be established, since we could not control for all possible factors explaining this improvement. For instance, it was not possible to study in detail the physical activity levels, type of comorbidities, and medication, which might have potential effects in functional status [ 4 , 48 ]. Therefore, more research is needed to corroborate our findings and establish an adequate frequency for clinical monitoring of people with COPD [ 49 ].…”

“…Functional status is an important and meaningful outcome in people with COPD [ 3 ]. It refers to the ability to provide for life’s necessities, i.e., activities that people do during their lives to meet basic needs, fulfil usual roles, and maintain their health and wellbeing [ 4 , 5 ]. Prior evidence has shown that poor functional status is a predictor of acute exacerbations, hospital admissions, and increased mortality in people with COPD [ 6 , 7 ].…”

Ageing with Interstitial lung disease: preserving health and well being

“…Frailty poses a possible three-fold increase in mortality in lung diseases [5 ▪ ,6–8]. Incident frailty is high across ILDs and influences time to mortality [5 ▪ ,9,10 ▪▪ ,11 ▪▪ ,12 ▪▪ ,13,14,15,16,17 ▪ ] and transplant success [9,10 ▪▪ ].…”

Pathogenesis and Nutritional Intervention of Chronic Obstructive Pulmonary Disease-Associated Frailty

“…The characteristic frailty symptoms of weariness, lethargy, and decreased activity are more prevalent in COPD patients, and this decline in function is brought on by a reduction in muscle mass and muscle oxidative capacity, in which GDF plays a crucial regulatory role (32). The systemic characteristics of COPD, such as increased inflammatory signaling, oxidative stress, and hypoxia, can all cause an increase in the expression of GDF15, which is a stress-responsive growth regulator (33).…”