Patients with COPD, preserved ratio impaired spirometry have faster frailty progression

Key takeaways:

• Patients with preserved ratio impaired spirometry (PRISm) had a higher baseline frailty index score than those with COPD and normal spirometry.
• There is a link between frailty index rises and COPD and PRISm.

Frailty progression occurred at a faster rate among patients with COPD and preserved ratio impaired spirometry vs. those with normal spirometry, according to results published in CHEST.

Preserved ratio impaired spirometry, or PRISm, is described as FEV₁ of less than 80% predicted with a FEV₁/FVC ratio of 0.7 or higher, according to researchers.

“In this population-based cohort study, we found the significant associations of PRISm findings and COPD with frailty progression,” Di He, BS, of Sir Run Shaw Hospital and Zhejiang University School of Medicine, and colleagues wrote.

Using data from the English Longitudinal Study of Aging, He and colleagues assessed 5,901 patients (mean age, 65.5 years; 54.9% women) to find out how PRISm findings and COPD are linked to frailty progression during a median follow-up period of 9.5 years.

Within the total cohort, 3,496 patients (mean age, 64.5 years; 56.5% women) had normal spirometry, 817 (mean age, 66.9 years; 57.9% women) had PRISm and 1,588 (mean age, 67.1 years; 49.9% women) had COPD.

Several baseline characteristics significantly differed (P < .001) between those with normal spirometry and those with either PRISm or COPD, including:

• education level (less than high school, 35.6% vs. 45.8% vs. 43.6%);
• marital status (married/partnered, 74.6% vs. 65.6%% vs. 66.5%);
• tobacco use status (never, 41.9% vs. 34.1% vs. 28.3%);
• drinking status (> 5 times a week, 22.6% vs. 17.7% vs. 25.1%);
• physical activity (inactive, 13.8% vs. 27.5% vs. 19.7%);
• mean BMI (28.1 kg/m² vs. 28.8 kg/m² vs. 27.2 kg/m²); and
• median frailty index (7.48 vs. 13.5 vs. 10.38).

In a covariate-adjusted model, researchers observed a significant rise in annual frailty index signaling faster progression among those with PRISm vs. normal spirometry (B = 0.301; 95% CI, 0.211-0.392). This outcome was also found among those with COPD vs. normal spirometry (B = 0.172; 95% CI, 0.102-0.242).

Severe PRISm vs. mild PRISm was significantly linked to quicker frailty progression (B = 0.308; 95% CI, 0.213-0.404), as was Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 3 to 4 COPD vs. GOLD stage 1 and 2 COPD (B = 0.279; 95% CI, 0.147-0.411) in an adjusted model.

Researchers also sought to determine how transitions of PRISm findings after a 4-year interval are related to frailty progression during a median follow-up period of 5.8 years using 3,765 patients from the study population.

The transition from normal spirometry to PRISm, not PRISm to normal spirometry, was significantly linked to an elevated frailty index vs. stable normal spirometry (B = 0.242; 95% CI, 0.008-0.476).

Further, the transition from COPD to PRISm, not PRISm to COPD, was significantly linked to faster frailty progression vs. stable normal spirometry (B = 0.481; 95% CI, 0.186-0.776).

Similar to the findings from the analysis of the total cohort, researchers found a significant rise in annual frailty index among those with stable PRISm vs. stable normal spirometry (B = 0.263; 95% CI, 0.043-0.483).

“Further studies are needed to elucidate the causality of PRISm findings and COPD with frailty,” He and colleagues wrote.