Exploring the impact of frailty on patients with interstitial lung disease

Dr. Alyson Wong is a respirologist based at St. Paul’s Hospital and a Clinical Assistant Professor in UBC’s Department of Medicine, Division of Respiratory Medicine. She is one of the winners of the 2023 Carraresi Foundation Early Career Clinician Investigator Award alongside the BCCSU’s Dr. Britt Dennis.

Her funded project will explore the impact of frailty on prescribing patterns and medication tolerability in patients with interstitial lung disease, with the overarching objective of identifying gaps in care for frail patients.

Frailty is common in ILD patients

Interstitial lung disease (ILD), Dr. Wong’s area of practice, is an umbrella term that covers many conditions that result in inflammation and scarring of the lungs. Providence Health Care and St. Paul’s Hospital are leaders in ILD research.

Frailty is essentially a loss of cognitive or health reserves that contributes to an increased risk of adverse outcomes such as hospitalization and mortality.

“As a result, [frail people] are more prone to having difficulties recovering from acute illness and tolerating interventions and medications,” says Dr. Wong. ILD patients tend to be older, and frailty among them is very common, especially in patients with multiple comorbidities. In general, twenty per cent of ILD patients being treated need to stop because they experience a significant adverse event from that treatment.

The value of treatment versus the harm of side effects

It can be difficult for a clinician to know if a frail patient with ILD should be treated with medication that could slow their disease, or if the medication’s side effects would ultimately be more harmful. Dr. Wong has seen this challenge in her clinical practice, and has had difficult conversations with patients about whether or not they should start certain medications.

Her study hypothesizes that frail patients are less likely to be treated with ILD-specific therapies, because physicians may be reluctant to prescribe medications to them due to the higher risks of side effects and difficulties recovering from side effects. However, a survey found that most ILD patients felt that having the benefits of the medication was more important than the risks of potential side effects.

Currently, there is not enough data surrounding this topic to fully support one view or the other. Dr. Wong’s study aims to address this knowledge gap, determine how frailty affects ILD treatment, and help reconcile the differences between patient and physician views on ILD management.

In addition to determining if frail patients are more or less likely to be treated with ILD-specific therapies, the study will determine the rates that frail patients are stopping medication and the frequency of adverse events, compared to their non-frail counterparts.

Dr. Wong and her team will compare the prescribing patterns of ILD therapies between fit, vulnerable and frail patients using the Canadian Registry for Pulmonary Fibrosis (CARE-PF). CARE-PF is one of the largest ILD registries in the world, including over 5000 ILD patients from across Canada. St. Paul’s Hospital is CARE-PF’s leading site, with 1500 patients alone. Their patient cohort has been characterized using the Clinical Frailty Score, a comprehensive tool that incorporates mobility, ­function and cognition when determining degrees of frailty, in addition to a detailed medical history.

Providing data to address gaps in care

While frailty is associated with worse survival in patients with ILD, the underlying causes for this association are unclear. This study will explore whether the lack of ILD treatment contributes to worse survival in frail patients with ILD. It will address important gaps in care by providing data on how frail ILD patients are able to tolerate medication, which may help improve access to effective therapies for frail ILD patients.

“I’m excited, because in ILD, and in a lot of conditions in general, frailty is found in a high proportion of patients. Through this work I’m hoping that we can help advocate for patients and truly understand whether they are getting the best care possible, because if we see that frail patients are actually tolerating medications in the same way as a non-frail individual, then that actually removes a barrier in terms of them accessing treatments for their disease,” says Dr. Wong.

Dr. Wong’s study will serve to exemplify the meaning and purpose of the Carraresi Foundation Award by providing funds that will explore complicated research questions identified in the early stages of their medical career.