Frailty, Comorbidity, and COPD

Excerpt

Chronic Obstructive Pulmonary Disease (COPD) is the third most common cause of mortality in the U.S.A. (1). The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as “a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases” (2). COPD can directly lead to or accelerate co-morbidities through hypoxia, dyspnea, polycythemia, pulmonary hypertension, and decreased activity (Figure 1). Older age and decreased cognition may lead to incorrect inhaler techniques (3). Persons with COPD have an average of 7 co-morbidities compared to 3 for other persons (4). The existence of comorbidities is strongly related to COPD exacerbations and symptoms (5). The Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity (BODE) Index is a simple index predicting the risk of death in patients with COPD (6). Using the Frailty Index, a co-morbidity index of multiple morbidities, 56.6% of persons with COPD were found to be frail in the National Health and Nutrition Examination Survey (NHANES) (7). Not surprisingly, many of these persons had some functional disability. Patients with COPD are more likely to be frail than other patients (8). A meta-analysis found that patients with COPD were twice as likely to be frail (9). …