Frailty is associated with respiratory exacerbations and mortality in individuals with Chronic Obstructive Pulmonary Disease. Among those with a smoking history and normal spirometry, frailty's association with respiratory outcomes is less defined. Adjusting for smoking and lung function, frailty was associated with prospective respiratory exacerbation rate, severe exacerbations, and frequent exacerbations (OR 5.5(3.2-9.3. Frailty and prefrailty were associated with increased all-cause mortality (AHR: frailty 4.5(2.4-8.5; prefrailty 2.5(1.5-4.2. Baseline DunedinPACE of aging was associated with prospective frailty at 10-year follow-up. Frailty associated with respiratory exacerbations and mortality; findings persisted among individuals with normal spirometry, highlighting the relevance of evaluating for frailty in people with a history of smoking.

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