Impact of frailty on symptom burden in Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD), the sixth leading cause of death in the United States in 2022 and the third leading cause of death in England and Wales in 2022, is associated with high symptom burden, particularly dyspnea. Frailty is a complex clinical syndrome associ-ated with an increased vulnerability to adverse health outcomes. The aim of this review was to explore the current evidence of the influence of frailty on symptoms in patients with a confirmed diagnosis of COPD according to GOLD guidelines. Fourteen studies report a positive association between frailty and symptoms, including dyspnea, assessed with the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) scale. Data were analysed in a pooled a ran-dom-effects meta-analysis Mean Difference (MD). There was an association between COPD pa-tients living with frailty and increased score of CAT versus COPD patients without frailty [pooled SMD, 1.79 (95% CI 0.72-2.87); I2 =99%]. Lower association was found between frailty and dyspnea measured by mMRC scale versus COPD patients without frailty [pooled SMD, 1.91 (95% CI 1.15-2.66); I2 =98%]. The prevalence of frailty ranged from 8.8% to 82%, pre-frailty from 30.4% to 73.7% in people living with COPD. The available evidence supports the role of frailty in worsen-ing symptom burden in COPD patients living with frailty. The review shows that frailty is com-mon in patients with COPD. Future research is needed to have further details related to the data from CAT to improve our knowledge of the frailty impact in this population.