American Journal of Respiratory and Critical Care Medicine · May 2026
B102-05 The Prognostic Role of Frailty in Chronic Obstructive Pulmonary Disease: Preserving Low Frailty for Better Outcomes
By Choi S, Kim T, Kim H et al.
Abstract Rationale Frailty is a clinical syndrome reflecting reduced physiological reserve and increased vulnerability to stressors. Both frailty and chronological age are considered as major prognostic determinants in chronic obstructive pulmonary disease (COPD). However, their combined impact has not been fully evaluated in large-scale cohorts. This study aims to investigate the independent and joint effects of frailty and chronological age on clinical outcomes in patients with COPD, suggesting that low frailty mitigates the adverse influence of aging on disease prognosis. Methods We conducted a nationwide, retrospective cohort study including 1,505,638 adults aged 40-90 years diagnosed with COPD between January 2010 and December 2021. Frailty was assessed using a claims-based frailty index and categorized by score as low-risk (<5), intermediate-risk (5-15), and high-risk (>15). Chronological age was stratified into two groups, younger (<70 years) and older (≥70 years). The study population was consequently divided into six age-frailty categories: younger-low, younger-intermediate, younger-high, older-low, older-intermediate, and older-high frailty. The primary outcome was all-cause mortality obtained from national death registry data, and the secondary outcome was severe COPD exacerbations. Multivariable Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Results Among 1,505,638 patients, 784,962 (52.1%) were younger than 70 years, and 720,676 (47.9%) were 70 years or older. In the younger group, 637,679 (82.1%), 141,934 (18.1%), and 5,349 (0.7%) were classified as low, intermediate, and high frailty, respectively. In the older group, 459,541 (63.8%) had low frailty, 229,399 (31.8%) intermediate frailty, and 31,736 (4.4%) high frailty. Compared with the older-low frailty reference group, patients with intermediate frailty had increased risks of all-cause mortality (HR 1.19, 95% CI 1.17-1.21 in younger patients; HR 1.21, 95% CI 1.20-1.21 in older patients). Additionally, those with high frailty showed even greater risks (HR 2.66, 95% CI 2.54-2.78 in younger patients; HR 1.90, 95% CI 1.87-1.93 in older patients). A similar gradient was observed for severe COPD exacerbations. The younger-intermediate frailty (HR 1.11, 95% CI 1.09-1.14) and younger-high frailty groups (HR 1.98, 95% CI 1.83-2.13) had significantly higher risks of exacerbations compared with the older-low frailty group. These findings indicate that low frailty attenuates age-related risks in COPD. Conclusion We demonstrated that maintaining low frailty is strongly associated with favorable outcomes in patients with COPD, complementing the prognostic value of chronological age. Preserving low frailty should be emphasized as an integral component of comprehensive COPD management and a key strategy to promote healthy aging. This abstract is funded by: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (RS-2025-00519997).