Guo Dan, Huang Ke, Guan Xiaolong, Ding Ruoxi, Zhu Dawei, Zhao Yanan, Yang Ting, He Ping
Aerospace Science and Industry Corporation 731 Hospital, Beijing, China.
School of Public Health, Peking University, Beijing, China.
BMJ Open Respir Res. 2025 Jan 2;12(1):e002171. doi: 10.1136/bmjresp-2023-002171.
Chronic respiratory diseases (CRDs) have been shown to be associated with frailty, but these findings have not yet reached a consensus. The aim of this study was to investigate the association between CRDs and frailty in the elderly using a nationally representative data from China.
Data from the China Health and Retirement Longitudinal Study (CHARLS) were analysed, including 3309 frailty-free participants followed for three waves from 2011. Frailty was assessed using the physical frailty phenotype scale, and CRDs were conformed by self-reported physician diagnoses. Cox proportional hazard models were used to examine the association between baseline CRDs and subsequent frailty.
Among participants (mean age 67.07 years, 51.53% male), 497 (15.02%) had CRDs. During a mean follow-up of 46 months, 273 (8.25%) participants developed frailty. The incidence rate of frailty was significantly higher in the CRDs group (37.17% per 1000 person-years vs 18.41% per 1000 person-years, p<0.01). Adjusted for covariables, participants with CRDs had a 44% higher risk of developing frailty (HR = 1.44, 95% CI: 1.08 to 1.91). Specifically, asthma only (HR=1.89, 95% CI: 1.07 to 3.33) and asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) (HR=1.79, 95% CI: 1.19 to 2.69) were associated with a higher risk of frailty among the elderly, while COPD only was not (HR=1.11, 95% CI: 0.73 to 1.65).
This study shows a significant association between CRDs, particularly asthma only and ACO, and frailty in the elderly. We need to pay attention to the frailty status of CRDs patients and consider routine screening among them in both clinical practice and community settings. Active treatment and control of CRDs are necessary to avoid frailty caused by primary lung disease progression or exacerbation.
慢性呼吸道疾病（CRD）已被证明与衰弱相关，但这些发现尚未达成共识。本研究的目的是利用来自中国的全国代表性数据，调查老年人中CRD与衰弱之间的关联。
分析了中国健康与养老追踪调查（CHARLS）的数据，包括2011年起随访三轮的3309名无衰弱参与者。使用身体衰弱表型量表评估衰弱情况，CRD通过自我报告的医生诊断确定。采用Cox比例风险模型检验基线CRD与随后衰弱之间的关联。
在参与者中（平均年龄67.07岁，男性占51.53%），497人（15.02%）患有CRD。在平均46个月的随访期间，273名（8.25%）参与者出现衰弱。CRD组的衰弱发病率显著更高（每1000人年37.17%对每1000人年18.41%，p<0.01）。在对协变量进行调整后，患有CRD的参与者出现衰弱的风险高44%（风险比=1.44，95%置信区间：1.08至1.91）。具体而言，仅哮喘（风险比=1.89，95%置信区间：1.07至3.33）和哮喘-慢性阻塞性肺疾病（COPD）重叠（ACO）（风险比=1.79，95%置信区间：1.19至2.69）与老年人衰弱风险较高相关，而仅COPD则不然（风险比=1.11，95%置信区间：0.73至1.65）。
本研究表明CRD，特别是仅哮喘和ACO，与老年人衰弱之间存在显著关联。我们需要关注CRD患者的衰弱状况，并在临床实践和社区环境中考虑对他们进行常规筛查。积极治疗和控制CRD对于避免原发性肺部疾病进展或加重导致的衰弱是必要的。
