National Center for Geriatrics and Gerontology, Japan
Masaaki Kusunose is a pulmonologist working at the Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan. A few years ago, he used to work on basic experiment about the mechanism by which lung cancer cells acquire worse phynotype and how to intervene that alteration at the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine. He is now working as a physician and also engaged in clinical research related to the association between chronic lung diseases and frailty.
Introduction: Age is known to be a risk factor for COPD and also a predictor of mortality and hospital admission for exacerbations. Frailty is a geriatric syndrome recognized as a clinical state of physical, psychological and social vulnerability that embodies an increased risk of the requirement of care. The purpose of this study is to explore the relationship between frailty and physiological and patient-reported outcomes (PROs) in subjects with stable COPD.
Methods: We administered the Kihon Checklist that has been validated for frailty screening. We also assessed patient-reported measurements of health status and dyspnea using the COPD Assessment Test (CAT), the St. George’s Respiratory Questionnaire (SGRQ), the Hyland Scale, the Medical Outcomes Study 36-item short-form (SF-36), the Baseline Dyspnea Index (BDI) and the Dyspnea-12 (D-12). We also measured pulmonary function.
Results: Of 79 consecutive COPD outpatients, 38 (48.1%), 24 (30.4%) and 17 (21.5%) subjects were classified as robust, prefrail and frail, by using the total score of the Kihon Checklist. That score was significantly correlated with the CAT score (Spearman’s rank correlation coefficient (Rs)=0.38, p<0.01), the SGRQ total score (Rs=0.65, p<0.01), the Hyland Scale score (Rs=-0.54, p<0.01), all subscale scores of the SF-36 (Rs=-0.64 to -0.31, p<0.01), the BDI score (Rs=-0.46, p<0.01) and the D-12 score (Rs=0.41, p<0.01). We found no or only weak correlations between the total score of the Kihon Checklist and lung function measurements. Using stepwise multiple regression analyses to identify the variables that predicted the total score of the Kihon Checklist, the SGRQ total score alone significantly explained 49.1% of the variance (p<0.01).
Conclusions: Frailty seems to be associated with PROs, especially health status, unlike lung function. Frailty should be assessed in addition to PROs separately from lung function as part of multidimensional analyses of COPD.