An Tai Joon, Lim Jihye, Lee Heayon, Ji Sunghwan, Jung Hee-Won, Baek Ji Yeon, Lee Eunju, Jang Il-Young
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Chest. 2024 Dec;166(6):1476-1486. doi: 10.1016/j.chest.2024.07.180. Epub 2024 Aug 27.
Breathlessness shares aging mechanisms with frailty and sarcopenia.
Are frailty and sarcopenia associated with breathlessness itself?
We analyzed data from a population-based, prospective cohort study of 780 community-dwelling older adults. Breathlessness was defined using the modified Medical Research Council dyspnea scale (≥ 2 points) and the COPD Assessment Test (≥ 10 points). Frailty was defined by frailty index (FI); frailty phenotype; and fatigue, resistance, ambulation, illness, and weight loss (FRAIL) questionnaire results. Sarcopenia was defined by the Asian Working Group for Sarcopenia in 2019. Sarcopenia phenotype score quantified the number of criteria met. The associations of frailty and sarcopenia with breathlessness were evaluated by logistic regression analyses. Adjusted ORs (aORs) were calculated, accounting for age, sex, chronic airway disease, smoking status, BMI, lung functions, socioeconomic status (living alone, income, education), comorbid conditions (hypertension, diabetes, malignancy, myocardial infarction, heart failure), and other geriatric contributors (cognitive dysfunction, depression, malnutrition, polypharmacy, fall history in the past year). Institutionalization-free survival was compared by log-rank test.
The prevalence of frailty was higher in the breathlessness group compared with the group without breathlessness (42.6% vs 10.5% by FI, 26.1% vs 8.9% by frailty phenotype, and 23.0% vs 4.2% by FRAIL questionnaire) and sarcopenia (38.3% vs 26.9%), with P < .01 for all comparisons. The multivariable logistic regression analyses showed that frailty (FI [aOR, 9.29], FRAIL questionnaire [aOR, 5.21], and frailty phenotype [aOR, 3.09]) and sarcopenia phenotype score (2 [aOR, 2.00] and 3 [aOR, 2.04] compared with 0) were associated with breathlessness. The cumulative incidence of institutionalization-free survival was higher in the breathlessness group than its counterparts (P = .02).
These findings suggest that frailty and sarcopenia strongly contribute to breathlessness in community-dwelling older adults. Measuring sarcopenia and frailty in older adults may offer opportunities to prevent age-related breathlessness.
呼吸急促与衰弱和肌肉减少症具有共同的衰老机制。
衰弱和肌肉减少症是否与呼吸急促本身相关？
我们分析了一项基于人群的前瞻性队列研究的数据，该研究涉及780名社区居住的老年人。呼吸急促采用改良的医学研究委员会呼吸困难量表（≥2分）和慢性阻塞性肺疾病评估测试（≥10分）进行定义。衰弱通过衰弱指数（FI）、衰弱表型以及疲劳、抵抗力、活动能力、疾病和体重减轻（FRAIL）问卷结果来定义。肌肉减少症采用2019年亚洲肌肉减少症工作组的定义。肌肉减少症表型评分量化了符合标准的数量。通过逻辑回归分析评估衰弱和肌肉减少症与呼吸急促的关联。计算调整后的比值比（aOR），并考虑年龄、性别、慢性气道疾病吸烟状况、体重指数、肺功能、社会经济状况（独居、收入、教育程度）、合并症（高血压、糖尿病、恶性肿瘤、心肌梗死、心力衰竭）以及其他老年因素（认知功能障碍、抑郁、营养不良、多种药物治疗、过去一年的跌倒史）。通过对数秩检验比较无机构化生存的累积发生率。
与无呼吸急促的组相比，呼吸急促组的衰弱患病率更高（FI定义分别为42.6%对10.5%，衰弱表型定义分别为26.1%对8.9%，FRAIL问卷定义分别为23.0%对4.2%）以及肌肉减少症患病率（38.3%对26.9%），所有比较的P值均<.01。多变量逻辑回归分析显示，衰弱（FI [aOR，9.29]、FRAIL问卷 [aOR，5.21] 和衰弱表型 [aOR，3.09]）以及肌肉减少症表型评分（与0相比，2 [aOR，2.00] 和3 [aOR，2.04]）与呼吸急促相关。呼吸急促组无机构化生存的累积发生率高于对照组（P = .02）。
这些发现表明，衰弱和肌肉减少症在很大程度上导致了社区居住老年人的呼吸急促。对老年人进行肌肉减少症和衰弱的评估可能为预防与年龄相关的呼吸急促提供机会。
