Can a better understanding of frailty improve the quality of life of patients with fibrotic interstitial lung diseases?

摘要

Management of progressive fibrotic interstitial lung diseases (ILDs) has long been limited to compensatory oxygen therapy and/or corticosteroids, but work in recent years has established the efficacy of new antifibrotic treatments in slowing the decline of patients with idiopathic pulmonary fibrosis [1]. However, many factors contribute to the tolerance and efficacy of new drugs in patients with ILDs. With this in mind, it is perhaps time to develop a more holistic approach to care by considering ILDs in the context of ageing and other deficits, such as the severity of symptoms, the presence of comorbidities, and functional limitations [2]. The consequence of age-related accumulation of deficits is a decrease in the capacity to maintain homeostasis, which is marked by reduced physiological reserves (i.e. progressive homeostenosis) and results in increased vulnerability to stressors and intolerance to drugs. Such geriatric “frailty,” a concept first defined in the 1980s, is considered quite distinct from the functional losses associated with physiological ageing, comorbidities and disabilities, although there are, of course, strong interactions between them [3]. One traditional method of categorising frailty is the Composite Frailty Index (CFI), which is the cornerstone of the study by GULER et al. [4], published in this issue of the European Respiratory Journal.