Frailty in People with COPD: A Systematic Review of Prevalence, Trajectories, and Adverse Outcomes

Context: Frailty is common in people with COPD, however definitions of frailty are highly variable. Understanding prevalence, trajectories and outcomes associated important to inform interventions clinical management. Objective: This systematic review synthesizes the measurement prevalence within-person over time, associations between adverse health COPD. Study design: Systematic review. Dataset: Medline, Embase Web Science searched (1 January 2001-8 September 2021). Searches supplemented by forward citation searching hand-searching reference lists. Population studied: Inclusion criteria were observational studies adults (>18 years) from any setting. Instrument: Studies using measure included. Outcomes: trajectories, or association health-related outcomes. Results synthesized narrative synthesis and, where heterogeneity allowed, random-effects meta-analyses. Results: 53 eligible 11 different measures identified. Most phenotype (n=32), index (n=5) Kihon checklist (n=4). Sample size ranged 22-8074. Mean age 50-88 years. Prevalence estimates varied definitions, setting, 2.6% 80.9%. COPD changes time improved following pulmonary rehabilitation. Baseline airflow limitation, dyspnoea frequency exacerbations worsening status. was greater risk mortality (5/7 studies), exacerbation (7/11), hospital admission (3/4). Using (frail vs robust), pooled hazard ratio for 1.80 (95% CI 1.24-2.63) incident rate ratios 1.42 (0.94-2.17) 1.46 (1.10-1.92) hospitalisation. obstruction (11/14), (15/16), severity scores (10/12), poorer quality life (3/4) disability (1/1). Conclusion: a among an increased may indicate poor prognosis, but can be responsive intervention. Proactive identification aid stratification individuals whom interventions, such as rehabilitation, targeted.