Physical frailty, preserved ratio impaired spirometry and the incidence of chronic obstructive pulmonary disease：a population-based cohort study

Abstract Background Patients with COPD are prone to be accompanied by frailty, whether frailty poses a burden of developing COPD in in the general population remains unknown. The purpose of this study is to explore whether prefrailty and frailty increase the risk of COPD, and whether the risk of COPD is significantly increased in the preserved ratio impaired spirometry population with frailty. Methods We included 412,351 adults without COPD at baseline in UK Biobank study. Frailty phenotypes were assessed using five components (weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength). Cox proportional hazard regression models were used to analyze the association between frailty and the incidence of COPD, as well as the impact of frailty in conjunction with preserved ratio impaired spirometry on the incidence of COPD. Results Among all participants, 243,777 (59.1%) were nonfrailty, 155,114 (37.6%) were prefrailty, and 13,460 (3.3%) were frailty. During a median follow-up of 13.5 years, 10,695 COPD cases were recorded. In the multivariable-adjusted model, frailty and prefrailty significantly increased the risk of COPD (HR 2.22, 95%CI: 2.07, 2.38 for frailty and HR 1.45, 95%CI: 1.39, 1.51 for prefrailty). The hazard ratio for the incidence of COPD in individuals with both frailty and preserved ratio impaired spirometry was 4.34 (95%CI: 3.69, 5.12). Conclusions Prefrailty and frailty were associated with an increased risk of COPD. Such association was independent of socioeconomic factors, lifestyles, morbidities, and genetic susceptibility, and modified by preserved ratio impaired spirometry status.