Unravelling the Nature of Physical Frailty and Sarcopenia in Acute and Chronic Respiratory Disease

Acute and chronic respiratory disease represent a common and challenging group of conditions associated with substantial morbidity and mortality while physical frailty and sarcopenia represent models of decline in physical function and strength usually applied to older individuals. This thesis aims to explore how these models apply to individuals with respiratory disease.

Results obtained from two observational studies are presented with the first examining changes in exacerbation frequency and physical activity changes among individuals with chronic obstructive pulmonary disease (COPD) during the COVID-19. The second study provides detailed measures of frailty, body composition and physical performance obtained during one year follow up following hospitalisation for COVID-19.

Among COPD patients a significant increase in the frequency of rescue treatment for acute exacerbations was seen despite a notable decline in the frequency of hospital admissions as compared to the same period one year prior to the COVID-19 pandemic lockdown. Additionally behavioural changes including reduced physical activity and increased medication adherence were reported. In the follow up study of 2793 patients hospitalised for COVID-19 a substantial burden of physical frailty was noted alongside significant adiposity which was associated with self-reported non-recovery. Measures of physical performance identified older age and obesity as particular risk factors for sustained reduced performance up to one year.

Physical frailty and sarcopenia provide models that can be used to better understand observed outcomes among individuals with acute and chronic respiratory disease.