Chronic obstructive pulmonary disease (COPD) is a long-term, debilitating disease characterised by progressive airflow limitation.(1) It is one of the main causes of morbidity and mortality worldwide,(2) and is expected to become the third highest cause of death and the fifth highest cause of disability adjusted life years by 2020.(3) The global cost of illness for COPD was US$2.1 trillion in 2010 and is expected to increase to $4.8 trillion by 2030.(4) COPD is associated with various systemic manifestations including skeletal muscle wasting and weakness, dyspnea, fatigue, and functional decline.(1, 5, 6)

Frailty has been described as a syndrome in which cumulative deficits in the reserve capacity of multiple physiological systems result in an increased vulnerability to dependency or mortality when the frail individual experiences a stressor event.(7-9) Fried and colleagues …show more content…
Frailty has been associated with adverse outcomes in COPD, including increased risk of disability,(15) death,(16) and hindering pulmonary rehabilitation,(13) which is a central component of COPD management shown to be highly effective in improving symptom burden and physical function.(17, 18) Frailty has also been associated with impairment in activities of daily living,(7, 19-21) and in people with COPD, those who are frail have more difficulty getting dressed, doing household chores, preparing meals, and feeding compared to those who are