Frail patients with chronic obstructive pulmonary disease (COPD) are more likely to be hospitalized for acute disease exacerbations, suggests a recent study presented at ATS 2023, held last month in Washington, DC. The study findings were also published in the American Journal of Respiratory and Critical Care Medicine.¹

In this prospective study, 172 patients with COPD were enrolled from May 2018 to January 2019 to determine the factors that were predictive of hospitalization. The median age of the selected patients was 68 years and they were followed up for 12-15 months. Symptoms were evaluated with the CAT score and MRC dyspnea scale; the FRAIL scale was used to measure frailty, while comorbidities were examined with the Charlson Comorbidities Index.

Twelve percent of the patients were smokers, 22% had asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome. Almost half (48.3%) of the patients were found to be frail. The median CAT score was 15, the median MRC score was 3, while the median score on the FRAIL scale was 2. The median FEV1% post-bronchodilator was 51.3%. Majority (86.6%) were taking the prescribed treatment; of these, 75% were also using inhaled steroids along with long-acting bronchodilators.

Nearly 20% of the participants gave a history of being hospitalized for exacerbation of COPD at the time of their recruitment. The hospitalization rate was found to be 0.33 per patient during the follow up. At the time of the first assessment, the hospitalization rate was 9.4% and at the last evaluation, this had reduced to 3.8%. “Only frailty and “time in follow up” were statistically and clinically relevant”. For every 1 unit increase in frailty on the FRAIL scale, the likelihood of COPD hospitalization increased 41% with adjusted odds ratio of 1.41. This study therefore demonstrated that frail COPD patients are at greater risk of related hospitalization. Identification of frail patients may allow targeted interventions to reduce the risk of exacerbations and subsequent hospitalization.

Reference

1. Ferreira AG, et al. Abstract 408. Frailty is a risk factor for chronic obstructive pulmonary disease hospitalization. Am J Respir Crit Care Med. 2023;207:A1136. https://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A1136.