Malnutrition, poor quality of life and disability: part of the complexity of Chronic Obstructive Pulmonary Disease (COPD) and their influence on the rate of acute exacerbations

<bold>Background:</bold> Current management of COPD is predominantly focused and limited to respiratory aspects. Multidimensional assessment incorporating nutritional assessment, quality of life, and disability into clinical practice would better examine the complexity of COPD patients. <bold>Methods:</bold> Observational prospective study enrolling 114 participants with stable COPD and at high risk of acute exacerbations according to the GOLD 2023 report; each participant underwent 52 weeks of follow-up. We performed spirometry, Mini-Nutritional Assessment (MNA), Euro-Qol-5D-3L (EQ-5D-3L) and Barthel Index (BI); dyspnea was assessed by mMRC and CAT test. The primary outcome was a composite of moderate or severe acute exacerbations during 52 weeks of follow-up. <bold>Results:</bold> The Pearson's correlation analysis showed that MNA, EQ-5D-3L and BI score were significantly correlated with each other as well as with the main clinical-spirometric COPD variables. Multiple linear regression analysis (mMRC as dependent variable) showed that MNA, EQ-5D-3L score were significantly associated with dyspnea severity and GOLD class (class 2: p: 0.01; class 3: p: 0.005; class 4: p: 0.001). Cox regression analysis showed that a one-point increase in MNA and BI score reduced the risk of our primary outcome by 3% (P: 0.006) and 14% (P: 0.0034), respectively. The log-rank test showed that the higher the level of disability, the higher the mortality rate. <bold>Conclusions:</bold> A shift from a dyspnea/FEV1-guided approach to a multidimensional assessment could significantly improve patient care in highly complex elderly COPD patients.