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Aging, Sarcopenia, and Frailty in Chronic Respiratory Diseases
Envejecimiento, sarcopenia y fragilidad en el contexto de las enfermedades crónicas respiratorias
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"Rodríguez Mañas" "email" => array:1 [ 0 => "Leocadio.rodriguez@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Isabel" "apellidos" => "Rodríguez Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Geriatría, Hospital Universitario de Getafe, CIBERFES, Getafe, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Envejecimiento, sarcopenia y fragilidad en el contexto de las enfermedades crónicas respiratorias" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lung diseases are among the most prevalent diseases in the elderly population.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Chronic obstructive pulmonary disease (COPD) is a prime example of a chronic disease, and elderly patients typically present many features of this disease: the associated functional decline, the very high burden of comorbidity (involving particularly other chronic diseases such as diabetes or cardiovascular diseases) and polypharmacy, and the need for complex therapeutic strategies that range from lifestyle changes (physical activity and nutrition) to continuity of care, adjusted to the patient's changing needs over the course of the disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Perhaps one of the most important features of this comorbidity is its impact on the autonomy of elderly patients.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> Autonomy has been shown to be a fundamental factor in the health of these patients, since functional status has been shown to be the main predictor of significant clinical events, including death, permanent institutionalization, quality of life, risk of hospitalization, and use of other health resources.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Indeed, numerous studies have found that functional status predicts much of the impact of the disease on many of these outcomes.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> This predominance of function over the specific disease, whether alone or in association with other comorbidities, has prompted the World Health Organization to define healthy aging in terms of function, rather than disease, as “the process of developing and maintaining the functional ability that enables wellbeing in older age”.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> The same document goes on to state that the impact of multimorbidity on function and quality of life is greater than the sum of the effects of each of the separate diseases, underlining the need for global and integrated management approaches.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Having established this paradigm, we must now act accordingly. However, it might first be useful to briefly review how functional capacity declines during the aging process. Functional decline that occurs as we age depends basically on 2 conditions, the first being aging itself: after the age of 25–30 years, maximum oxygen consumption declines by around 1% yearly (VO<span class="elsevierStyleInf">2max</span>/year).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> This generates a series of deleterious effects, which also involve the respiratory system, and lead to a series of chronic diseases and conditions which accelerate the aging process, one of the most important of which is COPD. When functional decline advances far enough, the individual loses their reserve capacity, to the extent that low-intensity stressors are capable of triggering abrupt declines in function from which it is difficult to recover due to the individual's depleted functional reserve. This situation, in which the subject is basically independent, but at high risk of developing disability and other adverse events (death, hospitalization, institutionalization, falls) in situations of low-intensity stress, has been called frailty.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> The detection of frailty is simple and can be done in any clinical setting,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> and helps identify individuals who are at greater risk of developing hard-to-reverse functional decline, and who will benefit from a series of interventions.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The pathophysiology of frailty is characterized by the simultaneous involvement of multiple systems, that include the inflammatory/immune system, some hormonal axes (testosterone, estrogen, insulin, growth hormone), the musculoskeletal system, and the cardiovascular system.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> All these changes converge in many cases in the generation of sarcopenia, the main underlying pathophysiological mechanism of frailty that determines functional decline (decreased daily activity, decreased walking speed, decreased grip strength, etc.).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Both sarcopenia and low-grade inflammation are common findings in patients with COPD. About 25% of patients with COPD have sarcopenia; this prevalence is even higher in older patients and indicates a worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> It is not surprising, then, that COPD patients often present frailty. In fact, frailty has been reported in subjects with COPD at rates varying between 10% in a European cohort<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> and 57.8% in the NHANES cohort<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>; furthermore, frail subjects had a worse prognosis. Not only do COPD patients have an increased risk of frailty, the functional progress of patients with frailty is worse.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> In addition to this generally worse functional prognosis, frail patients with COPD are at increased risk of complications not directly related to their lung function. Patients with COPD and sarcopenia have a lower bone mineral density, a higher prevalence of osteopenia and osteoporosis and, consequently, a higher risk of fractures,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> conferring a worse functional prognosis and higher mortality.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">What can we do? A series of practical steps emerge from the aspects discussed so far. The first of these is screening for frailty in all elderly patients with any chronic lung disease, and with COPD in particular. Secondly, we already know that interventions can be performed, even in elderly patients with COPD. In a recent study in COPD patients with an average age of 70 years, frail patients who completed the rehabilitation program experienced a marked improvement in functional parameters, and almost two thirds of the cohort could reverse their condition of frailty.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Finally, we will have to get used to managing elderly patients globally, in the understanding that the different comorbidities interact with one another, finally affecting patients’ ability to function and compromising their autonomy. Geriatrics departments and geriatricians are always available to assist in this approach.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez Mañas L, Rodríguez Sánchez I. Envejecimiento, sarcopenia y fragilidad en el contexto de las enfermedades crónicas respiratorias. Arch Bronconeumol. 2019;55:118–119.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asthma COPD and comorbidities in elderly people" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Bozek" 1 => "B. Rogala" 2 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 46 | 20 | 66 |
| 2024 September | 57 | 20 | 77 |
| 2024 August | 72 | 36 | 108 |
| 2024 July | 70 | 27 | 97 |
| 2024 June | 64 | 24 | 88 |
| 2024 May | 84 | 30 | 114 |
| 2024 April | 69 | 23 | 92 |
| 2024 March | 58 | 23 | 81 |
| 2024 February | 49 | 19 | 68 |
| 2023 August | 2 | 1 | 3 |
| 2023 March | 12 | 6 | 18 |
| 2023 February | 58 | 24 | 82 |
| 2023 January | 48 | 31 | 79 |
| 2022 December | 56 | 26 | 82 |
| 2022 November | 52 | 30 | 82 |
| 2022 October | 71 | 41 | 112 |
| 2022 September | 37 | 34 | 71 |
| 2022 August | 52 | 40 | 92 |
| 2022 July | 40 | 57 | 97 |
| 2022 June | 55 | 43 | 98 |
| 2022 May | 58 | 38 | 96 |
| 2022 April | 80 | 24 | 104 |
| 2022 March | 89 | 44 | 133 |
| 2022 February | 40 | 34 | 74 |
| 2022 January | 25 | 34 | 59 |
| 2021 December | 43 | 42 | 85 |
| 2021 November | 32 | 46 | 78 |
| 2021 October | 36 | 40 | 76 |
| 2021 September | 30 | 45 | 75 |
| 2021 August | 23 | 30 | 53 |
| 2021 July | 20 | 19 | 39 |
| 2021 June | 27 | 49 | 76 |
| 2021 May | 47 | 34 | 81 |
| 2021 April | 83 | 99 | 182 |
| 2021 March | 39 | 30 | 69 |
| 2020 May | 1 | 2 | 3 |
| 2020 March | 20 | 12 | 32 |
| 2020 February | 32 | 12 | 44 |
| 2020 January | 26 | 15 | 41 |
| 2019 December | 27 | 18 | 45 |
| 2019 November | 26 | 12 | 38 |
| 2019 October | 33 | 12 | 45 |
| 2019 September | 28 | 17 | 45 |
| 2019 August | 3 | 5 | 8 |
| 2019 March | 1 | 0 | 1 |
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