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Association between frailty index, lung function, and major clinical determinants in chronic obstructive pulmonary disease

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Abstract

Background

Airflow limitation alone is unable to capture the complexity of chronic obstructive pulmonary disease (COPD), better explained by comprehensive disease-specific indexes. Frailty is a clinical condition characterized by high vulnerability to internal and external stressors and represents a strong predictor of adverse outcomes.

Aims

Primary objective was to test the association between indexes of lung function and COPD severity with frailty index (FI), and secondary to evaluate the association between FI and comorbidities, cognitive and physical function, BODE index, and mortality.

Methods

150 stable COPD outpatients were enrolled and followed up to 4 years. At baseline, participants performed a geriatric multidimensional assessment, pulmonary function tests, arterial blood gas analysis, 6-min walking test, and bioimpedance analysis. BODE and FI were calculated. Spearman’s ρ was used to assess correlations. Mortality was assessed using Kaplan–Meier curves.

Results

Participants were followed up for a median of 39 months. Mean age was 73 years and median frailty index 0.15 (IQR 0.11–0.19). FI was higher in frequent exacerbators (≥ 2/year) (mean 0.18 vs 0.15, p 0.01) and dyspnoeic patients (mMRC ≥ 2) (mean 0.21 vs 0.14, p < 0.01) and correlated with lung volumes, expiratory flows, and pressure of arterial oxygen. FI was positively correlated with the number of comorbidities, depressive symptoms, cognitive decline, and BODE index. Mortality was higher in patients with BODE higher than 3 (HR 3.6, 95% CI 1.2–10.9), and not associated with FI.

Discussion

FI positively correlates with all clinical drivers orienting the choice of treatment in COPD.

Conclusions

FI associates with lung function and COPD severity, but does not associate with mortality.

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References

  1. Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762. https://doi.org/10.1016/S0140-6736(12)62167-9

    Article  PubMed  Google Scholar 

  2. Cesari M, Pérez-Zepeda MU, Marzetti E (2017) Frailty and multimorbidity: different ways of thinking about geriatrics. J Am Med Dir Assoc 18:361–364. https://doi.org/10.1016/j.jamda.2016.12.086

    Article  PubMed  Google Scholar 

  3. Buta BJ, Walston JD, Godino JG et al (2016) Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev 26:53–61. https://doi.org/10.1016/j.arr.2015.12.003

    Article  PubMed  Google Scholar 

  4. Mitnitski AB, Mogilner AJ, Rockwood K (2001) Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal 1:323–336. https://doi.org/10.1100/tsw.2001.58

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Houben-Wilke S, Augustin IM, Vercoulen JH et al (2018) COPD stands for complex obstructive pulmonary disease. Eur Respir Rev. https://doi.org/10.1183/16000617.0027-2018

    Article  PubMed  Google Scholar 

  6. Bellia V, Catalano F, Pistelli R et al (2004) Aging on quality of spirometry. Am J Respir Crit Care Med 170:100. https://doi.org/10.1164/ajrccm.170.1.962 (author reply 100–101)

    Article  PubMed  Google Scholar 

  7. Gale NS, Albarrati AM, Munnery MM et al (2018) Frailty: a global measure of the multisystem impact of COPD. Chron Respir Dis 15:347–355. https://doi.org/10.1177/1479972317752763

    Article  PubMed  PubMed Central  Google Scholar 

  8. Finamore P, Pedone C, Scarlata S et al (2018) Validation of exhaled volatile organic compounds analysis using electronic nose as index of COPD severity. Int J Chron Obstruct Pulmon Dis. 13:1441–1448. https://doi.org/10.2147/COPD.S159684

  9. Celli BR, Cote CG, Marin JM et al (2004) The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 350:1005–1012. https://doi.org/10.1056/NEJMoa021322

    Article  CAS  PubMed  Google Scholar 

  10. Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338. https://doi.org/10.1183/09031936.05.00034805

    Article  CAS  PubMed  Google Scholar 

  11. Pellegrino R, Viegi G, Brusasco V et al (2005) Interpretative strategies for lung function tests. Eur Respir J 26:948–968. https://doi.org/10.1183/09031936.05.00035205

    Article  CAS  PubMed  Google Scholar 

  12. Wanger J, Clausen JL, Coates A et al (2005) Standardisation of the measurement of lung volumes. Eur Respir J 26:511–522. https://doi.org/10.1183/09031936.05.00035005

    Article  CAS  PubMed  Google Scholar 

  13. Johannessen A, Nilsen RM, Storebø M et al (2013) Comparison of 2011 and 2007 global initiative for chronic obstructive lung disease guidelines for predicting mortality and hospitalization. Am J Respir Crit Care Med 188:51–59. https://doi.org/10.1164/rccm.201212-2276OC

    Article  PubMed  Google Scholar 

  14. Gedebjerg A, Szépligeti SK, Wackerhausen L-MH et al (2018) Prediction of mortality in patients with chronic obstructive pulmonary disease with the new global initiative for chronic obstructive lung disease 2017 classification: a cohort study. Lancet Respir Med 6:204–212. https://doi.org/10.1016/S2213-2600(18)30002-X

    Article  PubMed  Google Scholar 

  15. Mahler DA, Wells CK (1988) Evaluation of clinical methods for rating dyspnea. Chest 93:580–586. https://doi.org/10.1378/chest.93.3.580

    Article  CAS  PubMed  Google Scholar 

  16. Linn BS, Linn MW, Gurel L (1968) Cumulative illness rating scale. J Am Geriatr Soc 16:622–626. https://doi.org/10.1111/j.1532-5415.1968.tb02103.x

    Article  CAS  PubMed  Google Scholar 

  17. Jones PW, Harding G, Berry P et al (2009) Development and first validation of the COPD assessment test. Eur Respir J 34:648–654. https://doi.org/10.1183/09031936.00102509

    Article  CAS  PubMed  Google Scholar 

  18. Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727. https://doi.org/10.1111/j.1532-5415.1983.tb03391.x

    Article  CAS  PubMed  Google Scholar 

  19. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  CAS  PubMed  Google Scholar 

  20. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198. https://doi.org/10.1016/0022-3956(75)90026-6

    Article  CAS  PubMed  Google Scholar 

  21. Shulman KI, Shedletsky R, Silver IL (1986) The challenge of time: clock-drawing and cognitive function in the elderly. Int J Geriatr Psychiatry 1:135–140. https://doi.org/10.1002/gps.930010209

    Article  Google Scholar 

  22. Julian LJ, Gregorich SE, Earnest G et al (2009) Screening for depression in chronic obstructive pulmonary disease. COPD 6:452–458. https://doi.org/10.3109/15412550903341463

    Article  PubMed  Google Scholar 

  23. Searle SD, Mitnitski A, Gahbauer EA et al (2008) A standard procedure for creating a frailty index. BMC Geriatr 8:24. https://doi.org/10.1186/1471-2318-8-24

    Article  PubMed  PubMed Central  Google Scholar 

  24. Schols AM, Ferreira IM, Franssen FM et al (2014) Nutritional assessment and therapy in COPD: a European Respiratory Society statement. Eur Respir J 44:1504–1520. https://doi.org/10.1183/09031936.00070914

    Article  PubMed  Google Scholar 

  25. Ofenheimer A, Breyer-Kohansal R, Hartl S et al (2020) Reference values of body composition parameters and visceral adipose tissue (VAT) by DXA in adults aged 18–81 years-results from the LEAD cohort. Eur J Clin Nutr. https://doi.org/10.1038/s41430-020-0596-5

    Article  PubMed  PubMed Central  Google Scholar 

  26. Pedone C, Scarlata S, Forastiere F et al (2014) BODE index or geriatric multidimensional assessment for the prediction of very-long-term mortality in elderly patients with chronic obstructive pulmonary disease? A prospective cohort study. Age Ageing 43:553–558. https://doi.org/10.1093/ageing/aft197

    Article  PubMed  Google Scholar 

  27. Corlateanu A, Botnaru V, Covantev S et al (2016) Predicting health-related quality of life in patients with chronic obstructive pulmonary disease: the impact of age. Respiration 92:229–234. https://doi.org/10.1159/000448625

    Article  PubMed  Google Scholar 

  28. Scarlata S, Costanzo L, Giua R et al (2012) Diagnosis and prognostic value of restrictive ventilatory disorders in the elderly: a systematic review of the literature. Exp Gerontol 47:281–289. https://doi.org/10.1016/j.exger.2012.02.001

    Article  PubMed  Google Scholar 

  29. Pedone C, Scarlata S, Chiurco D et al (2012) Association of reduced total lung capacity with mortality and use of health services. Chest 141:1025–1030. https://doi.org/10.1378/chest.11-0899

    Article  PubMed  Google Scholar 

  30. Scarlata S, Pedone C, Fimognari FL et al (2008) Restrictive pulmonary dysfunction at spirometry and mortality in the elderly. Respir Med 102:1349–1354. https://doi.org/10.1016/j.rmed.2008.02.021

    Article  PubMed  Google Scholar 

  31. Bellia V, Pistelli R, Catalano F et al (2000) Quality control of spirometry in the elderly. The SA.R.A. study. Salute respiration nell’anziano = respiratory health in the elderly. Am J Respir Crit Care Med 161:1094–1100. https://doi.org/10.1164/ajrccm.161.4.9810093

    Article  CAS  PubMed  Google Scholar 

  32. Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495. https://doi.org/10.1503/cmaj.050051

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kennedy CC, Novotny PJ, LeBrasseur NK et al (2019) Frailty and clinical outcomes in chronic obstructive pulmonary disease. Ann Am Thorac Soc 16:217–224. https://doi.org/10.1513/AnnalsATS.201803-175OC

    Article  PubMed  PubMed Central  Google Scholar 

  34. Altenburg WA, de Greef MHG, ten Hacken NHT et al (2012) A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients. Respir Med 106:694–700. https://doi.org/10.1016/j.rmed.2011.11.008

    Article  PubMed  Google Scholar 

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Funding

This study was funded by an unrestricted grant from Fondazione Roma, Italy.

Author information

Authors and Affiliations

  1. Internal Medicine and Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio Medico University and Teaching Hospital, Via Alvaro del Portillo, 200, Rome, Italy

    Simone Scarlata, Panaiotis Finamore, Alice Laudisio, Mattia Ramaccia, Francesco D’Alessandro, Claudio Pedone & Raffaele Antonelli Incalzi

  2. Pulmonary Rehabilitation Unit, IRCCS San Raffaele Pisana Scientific Institute, Rome, Italy

    Vittorio Cardaci

  3. Geriatric Unit, Maugeri Clinical Research Institutes IRCCS, Milan, Italy

    Matteo Cesari

  4. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari

Authors
  1. Simone Scarlata
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  2. Panaiotis Finamore
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  3. Alice Laudisio
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  4. Vittorio Cardaci
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  6. Francesco D’Alessandro
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  8. Raffaele Antonelli Incalzi
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  9. Matteo Cesari
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Contributions

All the authors fulfill authorship criteria, have revised the final version of the manuscript, and gave their consent to publication.

Corresponding author

Correspondence to Simone Scarlata.

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None of the authors has any conflict of interest to disclose.

Ethical approval

The study protocol was approved by the Ethical Committee of Campus Bio-Medico University (30/15 PAR CMB). The investigation conforms to the principles outlined in the Declaration of Helsinki.

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All the study participants provided written informed consent.

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Scarlata, S., Finamore, P., Laudisio, A. et al. Association between frailty index, lung function, and major clinical determinants in chronic obstructive pulmonary disease. Aging Clin Exp Res 33, 2165–2173 (2021). https://doi.org/10.1007/s40520-021-01878-z

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  • DOI: https://doi.org/10.1007/s40520-021-01878-z

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