Physical Frailty Impacts Over 40% of Patients With COPD and Respiratory Failure

Physical frailty affects a large proportion of patients with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure and current tools for detection may be inadequate, according to a recent report.

More than 40% of patients with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure using a home-based intervention experience physical frailty and worse clinical outcomes, according to a recent study.

The prospective observational study, published in the International Journal of Chronic Obstructive Pulmonary Disease, is the first source documenting the prevalence of physical frailty in patients with severe COPD. It’s also the first to evaluate the usefulness of functional capacity tests for physical frailty, such as the short physical performance battery (SPPB) and the timed-up and go (TUG) evaluation.

Some researchers believe that patients with COPD and chronic respiratory failure have an increased risk of developing physical frailty because health-related quality of life (HRQoL), exercise capacity, muscle function, physical activity, and mortality are often diminished compared with patients with less severe COPD.

Additionally, physical frailty can impact a patient’s ability to engage in pulmonary rehabilitation (PR) programs and is associated with a 2-fold increase in not finishing the program, suggesting that early detection is crucial to better individualize interventions.

The time needed to complete a Fried phenotypic assessment, which is typically used to detect physical frailty in COPD, is difficult to conduct in a clinical setting. SPPB and TUG tests, which were originally used to detect frailty in older adults, may be a convenient and simple alternative to the Fried phenotypic assessment. However, there is no documentation on the use of these alternatives in predicting physical frailty in COPD.

In addition, gait speed is a component of SPPB tests and is considered a physical frailty criterion but it is not known how it contributes to Fried total scores.

The present study was part of a larger longitudinal study analyzing the long-term effectiveness of an 8-week home-based PR program on functional capacity and physical frailty in patients with COPD and chronic respiratory failure. Eligible patients had to be aged 40 or older and have a diagnosis for COPD and chronic respiratory failure.

Over the course of 2 at-home visits scheduled 7 days apart, patients had measurements taken for anthropometrics, anxiety, depressive symptoms, HRQoL, fatique, physical frailty, exercise tolerance and functional capacity.

Of the 55 patients contacted for participation, 44 were enrolled, a majority of whom were men, overweight, ex-smokers, had severe airway limitation, and experienced frequent exacerbations.

Physical frailty was observed in 19 (43%) patients. Among the nonfrail patients, 21 (47%) were identified as pre-frail and 4 (9%) patients did not fit any of the Fried criteria. Across groups, exhaustion was found to be the most common frailty marker, affecting 68% of all patients, 89% of frail patients, and 52% of nonfrail patients.

The investigators said that the results were higher than previous reports in patients with moderate-to-severe COPD and could be explained by the severe airflow limitations that patients with COPD and chronic respiratory failure face.

“These results underscore the challenge of health professionals when caring for patients with severe COPD, but also highlight the heavy clinical burden COPD patients with chronic respiratory failure have to deal with when starting a PR program,” wrote the investigators.

Compared with nonfrail patients, frail patients had lower daily step counts, exercise tolerance, and functional capacity (P < .05). Frail patients also had higher fatigue, anxiety, and depressive symptoms than nonfrail patients (P < .05).

When evaluating usefulness of SPPB and TUG assessments, the investigators found that according to the cut-offs used for evaluating the area under the curve, both tests were not accurate detection tools for physical frailty in COPD.

In addition, gait speed showed to be the main contributor to the total score of physical frailty amongst Fried criteria, suggesting that gait speed could serve as a simple screening tool for physical frailty in a similar population.

The investigators noted the exploratory nature of the study and the small sample size as study limitations. The results also cannot be generalized to milder COPD cases and adequately powered studies are needed to confirm the results.

Reference

Gephine S, Mucci P, Grosbois J-M, Maltais F, Saey D. Physical frailty in COPD patients with chronic respiratory failure. Int J Chron Obstruct Pulmon Dis. May 17, 2021;16:1381-1392. doi: 10.2147/COPD.S295885