Frailty in COPD: an analysis of prevalence and clinical impact using UK Biobank

Hanlon, P. , Lewsey, J. , Quint, J. K., Jani, B. D. , Nicholl, B. I. , McAllister, D. A. and Mair, F. S. (2022) Frailty in COPD: an analysis of prevalence and clinical impact using UK Biobank. BMJ Open Respiratory Research, 9, e001314. (doi: 10.1136/bmjresp-2022-001314) (PMID:35787523) (PMCID:PMC9255399)

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Background: Frailty, a state of reduced physiological reserve, is common in people with chronic obstructive pulmonary disease (COPD). Frailty can occur at any age; however, the implications in younger people (eg, aged <65 years) with COPD are unclear. We assessed the prevalence of frailty in UK Biobank participants with COPD; explored relationships between frailty and forced expiratory volume in 1 second (FEV1) and quantified the association between frailty and adverse outcomes. Methods: UK Biobank participants (n=3132, recruited 2006–2010) with COPD aged 40–70 years were analysed comparing two frailty measures (frailty phenotype and frailty index) at baseline. Relationship with FEV1 was assessed for each measure. Outcomes were mortality, major adverse cardiovascular event (MACE), all-cause hospitalisation, hospitalisation with COPD exacerbation and community COPD exacerbation over 8 years of follow-up. Results: Frailty was common by both definitions (17% frail using frailty phenotype, 28% moderate and 4% severely frail using frailty index). The frailty phenotype, but not the frailty index, was associated with lower FEV1. Frailty phenotype (frail vs robust) was associated with mortality (HR 2.33; 95% CI 1.84 to 2.96), MACE (2.73; 1.66 to 4.49), hospitalisation (incidence rate ratio 3.39; 2.77 to 4.14) hospitalised exacerbation (5.19; 3.80 to 7.09) and community exacerbation (2.15; 1.81 to 2.54), as was frailty index (severe vs robust) (mortality (2.65; 95% CI 1.75 to 4.02), MACE (6.76; 2.68 to 17.04), hospitalisation (3.69; 2.52 to 5.42), hospitalised exacerbation (4.26; 2.37 to 7.68) and community exacerbation (2.39; 1.74 to 3.28)). These relationships were similar before and after adjustment for FEV1. Conclusion: Frailty, regardless of age or measure, identifies people with COPD at risk of adverse clinical outcomes. Frailty assessment may aid risk stratification and guide-targeted intervention in COPD and should not be limited to people aged >65 years.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McAllister, Professor David and Jani, Dr Bhautesh and Hanlon, Dr Peter and Lewsey, Professor Jim and Mair, Professor Frances and Nicholl, Dr Barbara
Authors: Hanlon, P., Lewsey, J., Quint, J. K., Jani, B. D., Nicholl, B. I., McAllister, D. A., and Mair, F. S.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:BMJ Open Respiratory Research
Publisher:BMJ Publishing Group
ISSN (Online):2052-4439
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in BMJ Open Respiratory Research 9: e001314
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
305232Understanding prevalence and impact of frailty in chronic illness and implications for clinical managementFrances MairMedical Research Council (MRC)MR/S021949/1HW - General Practice and Primary Care