Preserved Ratio Impaired Spirometry and COPD Accelerate Frailty Progression

Abstract

BackgroundCOPD has been found to be associated with frailty. However, longitudinal evidence for associations of COPD with frailty progression is inadequate. Furthermore, recent studies revealed a new phenotype of lung function impairment: preserved ratio impaired spirometry (PRISm) findings. Associations of PRISm findings and their transitions with frailty progression are unclear.Research QuestionWhat are the associations of PRISm findings, transitions of PRISm findings, and COPD with frailty progression?Study Design and MethodsTo analyze the associations of PRISm findings and COPD with frailty progression, 5,901 patients were included from the English Longitudinal Study of Ageing. Patients were classified into three lung function patterns of normal spirometry (NS) findings, PRISm findings, and COPD. Frailty progression was assessed by repeated measurements of the frailty index (FI) during follow-up. Among these 5,901 patients, 3,765 patients were included to analyze the associations of PRISm findings transitions with frailty progression. PRISm findings transitions were assessed based on the changes of lung function patterns after a 4-year interval. Linear mixed-effect models were used for statistical analyses.ResultsThe median follow-up periods were 9.5 years for the analyses of PRISm findings and COPD with frailty progression and 5.8 years for PRISm findings transitions with frailty progression. When compared with participants with NS findings, patients with PRISm findings and COPD demonstrated accelerated FI progression with additional annual increases of 0.301 (95% CI, 0.211-0.392; P < .001) and 0.172 (95% CI, 0.102-0.242; P < .001), respectively. Patients who transitioned from NS findings to PRISm findings also demonstrated accelerated FI progression when compared with those with stable NS findings (β = 0.242; 95% CI, 0.008-0.476; P = .042). However, no accelerated FI progression was found in patients with PRISm findings who transitioned to NS findings (β = 0.119; 95% CI, –0.181 to 0.418; P = .438).InterpretationOur findings indicate that PRISm findings and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of the association of PRISm findings and COPD with frailty. COPD has been found to be associated with frailty. However, longitudinal evidence for associations of COPD with frailty progression is inadequate. Furthermore, recent studies revealed a new phenotype of lung function impairment: preserved ratio impaired spirometry (PRISm) findings. Associations of PRISm findings and their transitions with frailty progression are unclear. What are the associations of PRISm findings, transitions of PRISm findings, and COPD with frailty progression? To analyze the associations of PRISm findings and COPD with frailty progression, 5,901 patients were included from the English Longitudinal Study of Ageing. Patients were classified into three lung function patterns of normal spirometry (NS) findings, PRISm findings, and COPD. Frailty progression was assessed by repeated measurements of the frailty index (FI) during follow-up. Among these 5,901 patients, 3,765 patients were included to analyze the associations of PRISm findings transitions with frailty progression. PRISm findings transitions were assessed based on the changes of lung function patterns after a 4-year interval. Linear mixed-effect models were used for statistical analyses. The median follow-up periods were 9.5 years for the analyses of PRISm findings and COPD with frailty progression and 5.8 years for PRISm findings transitions with frailty progression. When compared with participants with NS findings, patients with PRISm findings and COPD demonstrated accelerated FI progression with additional annual increases of 0.301 (95% CI, 0.211-0.392; P < .001) and 0.172 (95% CI, 0.102-0.242; P < .001), respectively. Patients who transitioned from NS findings to PRISm findings also demonstrated accelerated FI progression when compared with those with stable NS findings (β = 0.242; 95% CI, 0.008-0.476; P = .042). However, no accelerated FI progression was found in patients with PRISm findings who transitioned to NS findings (β = 0.119; 95% CI, –0.181 to 0.418; P = .438). Our findings indicate that PRISm findings and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of the association of PRISm findings and COPD with frailty. Take-home PointsStudy Question: What are the associations of preserved ratio impaired spirometry (PRISm) findings, transitions of PRISm findings, and COPD with frailty progression?Results: Individuals with PRISm findings and COPD demonstrate accelerated frailty progression compared with individuals with normal spirometry (NS) findings. Individuals who transition from NS findings to PRISm findings also show accelerated frailty progression, whereas those who transition from PRISm findings to NS findings show similar frailty progression in comparison with individuals with stable NS findings.Interpretation: Our findings indicate that PRISm findings and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of the association of PRISm findings and COPD with frailty. Study Question: What are the associations of preserved ratio impaired spirometry (PRISm) findings, transitions of PRISm findings, and COPD with frailty progression? Results: Individuals with PRISm findings and COPD demonstrate accelerated frailty progression compared with individuals with normal spirometry (NS) findings. Individuals who transition from NS findings to PRISm findings also show accelerated frailty progression, whereas those who transition from PRISm findings to NS findings show similar frailty progression in comparison with individuals with stable NS findings. Interpretation: Our findings indicate that PRISm findings and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of the association of PRISm findings and COPD with frailty. Frailty, characterized by the functional declines across multiple physiologic systems and increased vulnerability to stressors, is becoming an emerging health burden worldwide.1Clegg A. Young J. Iliffe S. Rikkert M.O. Rockwood K. Frailty in elderly people.Lancet. 2013; 381: 752-762Abstract Full Text Full Text PDF PubMed Scopus (5769) Google Scholar, 2O’Donovan M. Sezgin D. Kabir Z. Liew A. O’Caoimh R. Assessing global frailty scores: development of a Global Burden of Disease-Frailty Index (GBD-FI).Int J Environ Res Public Health. 2020; 17: 5695Crossref PubMed Scopus (7) Google Scholar, 3Hoogendijk E.O. Afilalo J. Ensrud K.E. Kowal P. Onder G. Fried L.P. Frailty: implications for clinical practice and public health.Lancet. 2019; 394: 1365-1375Abstract Full Text Full Text PDF PubMed Scopus (1302) Google Scholar Epidemiologic surveys show that the prevalence of frailty ranges from 4% to 59% in community-dwelling older adults.4Collard R.M. Boter H. Schoevers R.A. Oude Voshaar R.C. Prevalence of frailty in community-dwelling older persons: a systematic review.J Am Geriatr Soc. 2012; 60: 1487-1492Crossref PubMed Scopus (2046) Google Scholar,5To T.L. Doan T.N. Ho W.C. Liao W.C. 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Transitions between frailty states among community-living older persons.Arch Intern Med. 2006; 166: 418-423Crossref PubMed Scopus (798) Google Scholar Therefore, it is of great importance to identify the risk factors of frailty; doing so provides the opportunity to implement targeted prevention and intervention for frailty at a specific time window. COPD is a of global and among older X. X. M. M. Liu X. Trends and risk factors of and years for from to systematic for the Global Burden of Study 2020; PubMed Scopus Google Scholar, D. P. Y. H. A. and prevalence and risk factors in a systematic review and Med. 2022; 10: Full Text Full Text PDF PubMed Scopus Google Scholar, D. A. A. et for the and prevention of lung the J. 2019; PubMed Scopus Google Scholar The of COPD are as and and as the to ratio of < D. A. A. et for the and prevention of lung the J. 2019; PubMed Scopus Google Scholar studies found that COPD was associated with risks of G. T.M. Frailty and in older J Med. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, R.C. Frailty and associated factors in community-dwelling elderly in 2012; PubMed Scopus Google Scholar, L. G. et of frailty in elderly with a PubMed Scopus Google Scholar However, these were based on Longitudinal evidence on the associations of COPD with frailty progression is inadequate. Furthermore, studies on COPD found a with in and in normal to P. et between preserved ratio impaired spirometry and clinical outcomes in 2021; PubMed Scopus Google Scholar, R. G. risk and clinical implications of preserved ratio impaired a cohort Med. 2022; 10: Full Text Full Text PDF PubMed Scopus Google Scholar, S. E.A. et and in preserved ratio impaired spirometry in the J Med. 2018; PubMed Scopus Google Scholar, M. et and of preserved ratio impaired the Study.Eur J. 2020; PubMed Scopus Google Scholar lung function phenotype is to as preserved ratio impaired spirometry lung function R. G. risk and clinical implications of preserved ratio impaired a cohort Med. 2022; 10: Full Text Full Text PDF PubMed Scopus Google Scholar The associations of PRISm findings with frailty progression unclear. PRISm findings transition to normal spirometry (NS) findings COPD S. E.A. et and in preserved ratio impaired spirometry in the J Med. 2018; PubMed Scopus Google M. et and of preserved ratio impaired the Study.Eur J. 2020; PubMed Scopus Google Scholar The associations of PRISm findings transitions with frailty progression also to be To these used from a prospective cohort of the English Longitudinal Study of to the associations of PRISm findings and COPD with frailty progression. also to the associations of PRISm findings transitions with frailty progression. The was a prospective cohort in the of the were A. J. 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The median follow-up time for these analyses was 5.8 with stable NS findings, patients with NS findings who transitioned to PRISm findings FI at (β = 95% CI, P < .001) and accelerated FI progression during follow-up (β = 0.242; 95% CI, 0.008-0.476; P = .042). The FI (β = 95% CI, P < .001) and accelerated progression of FI (β = 95% CI, P = .001) also were found in patients with COPD who transitioned to PRISm findings. However, patients who transitioned from PRISm findings to NS findings no accelerated progression of FI (β = 0.119; 95% CI, –0.181 to 0.418; P = with a in FI (β = 95% CI, to P = patients with stable PRISm findings FI (β = 95% CI, P < .001) and accelerated FI progression (β = 95% CI, P = those with stable NS findings. the of in the analyses. 7 the associations of lung function transitions with frailty progression. the and at and for transition of PRISm Transitions Frailty for for and (95% (95% to to to to to to NS to PRISm to PRISm PRISm to NS to to to COPD to to = normal preserved ratio impaired for for and in a new NS = normal preserved ratio impaired the of analyses when of from the the of normal to lung function for and and the patients with frailty at the of these analyses were with Patients with PRISm findings and COPD accelerated FI progression those with NS findings. Transitions from NS findings to PRISm findings, COPD to PRISm findings, and stable PRISm findings also accelerated FI progression those with stable NS findings, no accelerated progression of FI was in the transition from PRISm findings to NS findings. the of were when the multiple and patients with on analyses by and were found in and patients, and older patients, and individuals who and used cohort found the associations of PRISm findings and COPD with frailty progression. Patients with PRISm findings and COPD accelerated FI progression as compared with patients with NS findings. those who transitioned from NS findings to PRISm findings, transitioned from COPD to PRISm findings, and stable PRISm findings also demonstrated accelerated FI progression as compared with those with stable NS findings. However, no accelerated FI progression was found in the transition from PRISm findings to NS findings. studies the associations of COPD with G. T.M. Frailty and in older J Med. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, R.C. Frailty and associated factors in community-dwelling elderly in 2012; PubMed Scopus Google Scholar, L. G. et of frailty in elderly with a PubMed Scopus Google Scholar on the a that individuals with COPD risks of frailty individuals A. R. Onder G. K. The between COPD and a systematic review and of 2018; Full Text Full Text PDF PubMed Scopus Google Scholar However, evidence from longitudinal studies and their were et J. T. J. Transitions in frailty states among community-living older adults and their associated Am Full Text Full Text PDF PubMed Scopus Google Scholar that COPD the progression from to in patients, was in et S. et and of frailty transitions in older the in Am Geriatr Soc. PubMed Scopus Google Scholar found that COPD the of from to repeated measurements of the FI and mixed-effect the associations of COPD with frailty progression. Individuals with COPD accelerated progression of FI during follow-up individuals with NS findings. Our also were in and patients, and older and individuals who and used Our findings new evidence on the longitudinal associations of COPD with frailty progression. to also the associations of PRISm findings with frailty progression. PRISm findings was a phenotype of lung function that increased the risks of multiple adverse outcomes as cardiovascular disease, and all-cause P. et between preserved ratio impaired spirometry and clinical outcomes in 2021; PubMed Scopus Google Scholar, R. G. risk and clinical implications of preserved ratio impaired a cohort Med. 2022; 10: Full Text Full Text PDF PubMed Scopus Google Scholar, S. E.A. et and in preserved ratio impaired spirometry in the J Med. 2018; PubMed Scopus Google Scholar, M. et and of preserved ratio impaired the Study.Eur J. 2020; PubMed Scopus Google Scholar However, associations of PRISm findings with frailty progression were unclear. found that PRISm findings accelerated FI progression during follow-up in comparison with NS findings. of the normal and PRISm findings been in lung function and health Therefore, the of PRISm findings for the prevention of frailty progression. Furthermore, studies indicate that PRISm findings transition to NS findings COPD S. E.A. et and in preserved ratio impaired spirometry in the J Med. 2018; PubMed Scopus Google M. et and of preserved ratio impaired the Study.Eur J. 2020; PubMed Scopus Google Scholar Our with of PRISm findings to NS findings COPD after a 4-year follow-up. of patients with NS findings and of patients with COPD transitioned to PRISm findings. found that individuals who transitioned from NS findings to PRISm findings, transitioned from COPD to PRISm findings, and stable PRISm findings demonstrated accelerated progression of FI compared with those with stable NS findings. findings the adverse of PRISm findings on frailty progression. no accelerated progression of FI was in individuals who transitioned from PRISm findings to NS findings, great of PRISm findings for frailty progression. instruments been used to frailty in the A. Young J. Iliffe S. Rikkert M.O. Rockwood K. Frailty in elderly people.Lancet. 2013; 381: 752-762Abstract Full Text Full Text PDF PubMed Scopus (5769) Google Scholar, 2O’Donovan M. Sezgin D. Kabir Z. Liew A. O’Caoimh R. Assessing global frailty scores: development of a Global Burden of Disease-Frailty Index (GBD-FI).Int J Environ Res Public Health. 2020; 17: 5695Crossref PubMed Scopus (7) Google Scholar, 3Hoogendijk E.O. Afilalo J. Ensrud K.E. Kowal P. Onder G. Fried L.P. Frailty: implications for clinical practice and public health.Lancet. 2019; 394: 1365-1375Abstract Full Text Full Text PDF PubMed Scopus (1302) Google Scholar the used the FI to frailty. FI is a used frailty by Rockwood and K. A. Frailty in to the of PubMed Scopus Google Scholar The of the FI is that it is a that health from multiple and L. C. et the of frailty and PubMed Scopus Google Scholar The FI also is on frailty among frailty as the Fried frailty are among older J. C. Y. et al.Frailty index and all-cause and in Chinese adults: a prospective cohort Health. 2020; Full Text Full Text PDF PubMed Scopus Google Scholar the of the patients was to including and older Therefore, FI was for the However, FI also included of PRISm findings and COPD were to high of these the associations of PRISm findings and COPD with frailty P. et between preserved ratio impaired spirometry and clinical outcomes in 2021; PubMed Scopus Google R. G. risk and clinical implications of preserved ratio impaired a cohort Med. 2022; 10: Full Text Full Text PDF PubMed Scopus Google Scholar To analyses by these of from the Our were when the the of findings. The PRISm findings and COPD with frailty were studies that PRISm findings, and frailty similar risk as and P. et between preserved ratio impaired spirometry and clinical outcomes in 2021; PubMed Scopus Google R. G. risk and clinical implications of preserved ratio impaired a cohort Med. 2022; 10: Full Text Full Text PDF PubMed Scopus Google A. R. Onder G. K. The between COPD and a systematic review and of 2018; Full Text Full Text PDF PubMed Scopus Google Scholar similar risk factors the associations of PRISm findings and COPD with frailty. However, were after for the risk that PRISm findings and COPD for frailty. was as a among individuals with lung function between lung function and and a longitudinal in 2021; PubMed Scopus Google Scholar, P. A. et in and associated with in 2021; PubMed Scopus (8) Google Scholar, K. et in older with the 2021; PubMed Scopus Google Scholar, K. Qiao R. L. of in 2022; Scopus Google Scholar also has associations with K. C. Associations of and with frailty and among participants of the 2022; PubMed Scopus Google Scholar, A. R. by frailty and in older adults: a systematic review and Res 2022; PubMed Scopus Google Scholar, D. T. 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