Patients with chronic obstructive pulmonary disease (COPD) who were classified as frail were more likely to have lower quality of life, increased rate and length of hospitalization, and a higher rate of mortality compared with non-frail patients, according to the results of a study published in the Annals of the American Thoracic Society.

Health outcomes were retrospectively analyzed from the National Emphysema Treatment Trial (NETT). Patients were classified into either the frail or non-frail group according to the frailty phenotype conceptual model. Frail patients were defined as having ≥3 parameters of frailty such as body mass index decrease ≥5% over 12 months, self-reported exhaustion, low 6-minute walking distance scores, or physical activity or respiratory muscle strength in the lowest quartile. Participants meeting fewer than 3 criteria were considered non-frail. Participants were followed for 2 years.

Of the 902 study participants, the incidence rate of frailty was 6.4 per 100 person-years. Frail participants reported significantly worse disease-specific and overall quality of life, as measured by St. George’s Respiratory Questionnaire (mean difference, 11.6; P <.001). In addition, compared with their non-frail counterparts, frail participants had an increased incidence of hospitalization (adjusted hazard ratio, 1.6; P =.02) and 8-day increase in hospital use (P <.0001). Frail participants had a higher mortality rate (adjusted hazard ratio, 1.4; P =.07).

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“Further understanding of how the COPD frailty phenotype can be modified or treated and whether modification improves hospitalization, mortality, and quality of life outcomes are key topics for future research,” the researchers concluded.

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Kennedy C, Novotny P, LeBrasseur N, et al; for the NETT Research Group. Frailty and clinical outcomes in chronic obstructive pulmonary disease [published November 15, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201803-175OC