Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns

Background Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood. Aims To evaluate the association between frailty index and 5-year mortality across different “spirometric” patterns and the variation in their occurring frailty determinants. Methods This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex. Results Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10–3.32) for the overall cohort, 2.24 (95% CI 1.48–3.40) for obstructive defects, 2.45 (95% CI 1.12–5.36) for restrictive defects, and 2.79 (95% CI 1.41–3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37–2.84) for the overall cohort, 2.08 (95% CI 1.37–3.18) for obstructive defects, 2.27 (95% CI 1.04–1.17) for restrictive defects, and 2.21 (95% CI 1.20–3.08) for mixed airflow defects. Conclusion Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases.