Frailty and muscle weakness in elderly patients with asthma and their association with cumulative lifetime oral corticosteroid exposure

Ryu, Kai; Fukutomi, Yuma; Nakatani, Eiji; Iwata, Maki; Nagayama, Kisako; Yano, Koichi; Nakamura, Yasuhiko; Hamada, Yuto; Watai, Kentaro; Kamide, Yosuke; Sekiya, Kiyoshi; Araya, Jun; Kuwano, Kazuyoshi; Taniguchi, Masami

doi:10.1016/j.alit.2022.10.005

Cited by 12 publications

(13 citation statements)

References 48 publications

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“…Our study found a high age-sex standardized prevalence of frailty in older adults with asthma of 35.8% (95% CI 34.8%−36.7%) and an age-sex standardized prevalence of pre-frailty of 54.5% (95% CI 53.5%−55.5%), with a 3.3-fold increase in the prevalence of frailty in older adults with asthma compared to older adults without asthma. The results of our study are generally consistent with those of a small study who found a 37% prevalence of frailty among 203 older outpatients with asthma aged 60 years or older (17), and we report a higher prevalence of frailty among older adults with asthma than a Brazilian cohort study that reported 13% of older patients with current asthma had frailty in 2015 (18). Chronic inflammation in asthmatics is not only present in the respiratory tract but is systemic, characterized by increased levels of peripheral blood eosinophils, immunoglobulin E and type 2 cytokines.…”

Section: Discussionsupporting

confidence: 91%

“…Ryu et al reported a higher prevalence of frailty in older adults with asthma with longer lifetime OCS exposure (33% of patients with no lifetime OCS use, 59% of low-dose users, and 68% of high-dose users; p < 0.005 for trend). Suggesting that lifetime cumulative OCS exposure was associated with a high prevalence of weakness and muscle weakness (17). Although OCS is effective for asthma, it causes side effects including osteoporosis, fractures, diabetes, obesity, cardiovascular disease, and infections that may promote the onset of frailty.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological status and associated factors of frailty and pre-frailty in older adults with asthma in China: A national cross-sectional study

Zeng

Meng²,

Jia³

et al. 2023

Front. Public Health

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ObjectiveThere are few studies on the prevalence and factors associated with frailty and pre-frailty in older adults with asthma worldwide. The aim of this study was to examine the epidemiological status and factors associated with frailty and pre-frailty in older adults with asthma in China.Research design and methodsData were obtained from the Sample Survey of Aged Population in Urban and Rural China in 2015, a nationwide cross-sectional survey covering 224,142 older people aged 60 years or older in 31 provinces/autonomous regions/municipalities in mainland China. We performed frailty and pre-frailty assessments using the frailty index, and the diagnosis of asthma in the older adults was self-reported based on the history of the physician's diagnosis.ResultsNine thousand four hundred sixteen older adults with asthma were included in the study. The age-sex standardized prevalence of frailty and pre-frailty in Chinese older adults with asthma was 35.8% (95% CI 34.8%−36.7%) and 54.5% (95% CI 53.5%−55.5%). Multinomial logistic regression analysis showed that increased age, female, illiteracy, living alone, poor economic status, ADL disability, comorbid chronic diseases, previous hospitalization in the past year, and residence in northern China were associated with frailty and pre-frailty in older adults with asthma.ConclusionThe prevalence of frailty and pre-frailty in Chinese older adults with asthma is very high, and assessment of frailty should become routine in the management of older adults with asthma. Appropriate public health prevention strategies based on identified risk factors for frailty in older adults with asthma should be developed to reduce the burden of frailty in Chinese older adults with asthma.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Epidemiological status and associated factors of frailty and pre-frailty in older adults with asthma in China: A national cross-sectional study

Zeng

Meng²,

Jia³

et al. 2023

Front. Public Health

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“…In a recent study conducted in Japan, a positive association was found between lifetime cumulative corticosteroid exposure and a higher prevalence of muscle frailty and weakness. 30 In our study, no significant difference in muscle strength was found between the two groups of patients regarding their cumulative corticosteroid exposure. However, our study was not designed for this purpose and could have been underpowered to detect this relationship.…”

Section: Discussioncontrasting

confidence: 56%

Handgrip strength as a diagnostic tool for frailty risk in elderly patients with moderate to severe asthma

et al. 2023

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To evaluate handgrip strength (HGS) as a diagnostic tool for frailty risk in elderly patients with asthma, as well as to investigate the prevalence of frailty in this population. Methods: This was a cross-sectional study including 96 patients = 60 years of age diagnosed with moderate to severe asthma and treated at a tertiary referral center in Brazil. We measured HGS using a calibrated hydraulic hand dynamometer. We used a frailty scale and the AUC to assess the diagnostic accuracy of the HGS test. Results: The median age of participants was 67 years. Most (78%) were women and non-White (91%) of low socioeconomic status. HGS identified those at risk for frailty, with an AUC of 71.6% (61.5-80.4%; p < 0.002), as well as a sensitivity of 73.58% and a specificity of 67.53%, on the basis of a cutoff of = 19 kgf. Conclusions: HGS appears to be a simple, reliable tool for clinicians to determine frailty risk in older asthma patients in a point-of-care setting.

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“…ACO is an important subgroup of chronic respiratory diseases with characteristics of asthma and COPD, bearing a higher disease burden 35. The loss of muscle mass, muscle strength14 36 and nutrient intake,4 as well as many other extrapulmonary complications that may occur in asthma and COPD, are all components of frailty. Regarding frailty measurement, we have opted for the cumulative deficit model and employ the frailty index to identify frail individuals.…”

Section: Discussionmentioning

confidence: 99%

“…Emerging evidence has demonstrated that the odds of frailty is approximately twofold higher in patients with COPD11; furthermore, the copresence of frailty and COPD is associated with a higher risk of exacerbation, hospitalisation, major adverse cardiovascular event and all-cause mortality 12. Landré et al found that patients with asthma were also more likely to be frail13; and the higher prevalence among asthmatic over 60 years old was associated with cumulative lifetime oral corticosteroid exposure 14. Although COPD and asthma are unique diseases with distinct characteristics, they can coexist in a given individual, which is more common in middle-aged and elderly populations (aged ≥40 years) 15…”

Section: Introductionmentioning

confidence: 99%

Frailty in asthma-COPD overlap: a cross-sectional study of association and risk factors in the NHANES database

Wang

Wen

et al. 2023

BMJ Open Resp Res

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BackgroundAsthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a condition characterised by the simultaneous presence of features of both asthma and COPD. The study aims to investigate the association between ACO and frailty among middle-aged and elderly populations, and identify the risk factors for frailty in individuals with ACO.MethodsWe conducted a cross-sectional study with 34 403 eligible participants (aged ≥40 years) from the National Health and Nutrition Examination Survey 1999–2018 cycles. Participants were stratified into four groups: ACO, asthma, COPD and non-asthma/COPD. Frailty assessment was based on frailty index, generating frail and non-frail group. Univariate and multivariate survey-weighted logistic regression analysis were used to determine the association between ACO and frailty, and to identify the risk factors for frailty in ACO.ResultsThe frailty prevalence in participants with ACO was 60.2%, significantly higher than that in those with asthma (32.3%) and COPD (40.6%). In the unadjusted model, participants with ACO exhibited six-fold higher odds of frailty (OR 6.30, 95% CI 5.29 to 7.49), which was significantly greater than those with COPD (OR 2.84, 95% CI 2.46 to 3.28) and asthma (OR 1.99, 95% CI 1.80 to 2.18), using the non-asthma/COPD group as a reference. After adjusting for all confounders, participants with ACO had over four times higher odds of frailty (OR 4.48, 95% CI 3.53 to 5.71), still higher than those with asthma and COPD. The findings remained robust in sensitivity and subgroup analyses. Furthermore, hypertension, cancer, cardiovascular disease, chronic kidney disease and cognitive disorders were identified as risk factors for frailty among ACO participants, while higher income and education levels were protective factors.ConclusionPatients (aged ≥40 years) with ACO were at a higher risk of frailty, regardless of age or sex, compared with those with asthma or COPD alone. Greater attention should be paid to patients with ACO, regardless of their age.

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Frailty and muscle weakness in elderly patients with asthma and their association with cumulative lifetime oral corticosteroid exposure

Cited by 12 publications

References 48 publications

Epidemiological status and associated factors of frailty and pre-frailty in older adults with asthma in China: A national cross-sectional study

Epidemiological status and associated factors of frailty and pre-frailty in older adults with asthma in China: A national cross-sectional study

Handgrip strength as a diagnostic tool for frailty risk in elderly patients with moderate to severe asthma

Frailty in asthma-COPD overlap: a cross-sectional study of association and risk factors in the NHANES database

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