More than half of COPD patients suffer from severe fatigue yet it remains “very underestimated” as a symptom and could be better targeted by treatment, according to experts.
A Dutch study found that fatigue was particularly likely in stable COPD patients with worse dyspnoea, sleep quality, pain and fatigue-related catastrophising.
The data also suggested that patients using antidepressants or anxiolytics were at a higher risk of fatigue, as were those who had experienced more frequent exacerbations in the last year.
The findings highlight that “identifying fatigue and looking for treatable causes could make a difference to quite a number of patients with COPD,” Professor David Halpin, a consultant physician and Professor of Respiratory Medicine at the University of Exeter, told the limbus.
“Fatigue is a very underestimated symptom in COPD that – as they say in the paper – a lot of patients suffer from [but] is not often asked about or discussed in consultations,” he said.
“Some of the causes of fatigue are probably not susceptible to treatment, but other factors, [such as] anxiety, depression and behavioural attitudes, potentially are,” he added.
The study, published in ERJ Open Research [link here], involved 247 patients (40% female, mean age 67 years) in the Netherlands with stable COPD who were interviewed in-person and completed a questionnaire.
Patients reported subjective fatigue using the eight-item CIS-Fatigue score, with the mean score across the cohort at 36 points and 126 patients (51%) classified as having severe fatigue (CIS-Fatigue ≥36 points).
The data showed that higher dyspnoea (p=0.005), reduced sleep quality (p=0.017), higher pain (p=0.024) and higher fatigue-related catastrophising (p=0.012) were all significantly associated with higher fatigue.
“The association between fatigue-related catastrophising and fatigue is a novel finding which has never been researched before in COPD, but has been established in patients with interstitial lung diseases and other populations,” the study authors noted.
“A possible explanation for this relationship is that catastrophising can worsen the perception of fatigue, potentially leading to avoidance of, for example, physical activity, which in turn worsens fatigue,” they added.
Fatigue was also more likely in patients with a lower functional exercise capacity or a lower diffusion capacity, and those who had suffered a higher number of moderate exacerbations in the last year, showing that “optimising treatment to minimise the number of exacerbations is important,” Prof Halpin told the limbus.
Patients who used antidepressants, anxiolytics and systemic antihistamines were at a higher risk of fatigue, as were those who lived alone, had more comorbidities, or had lower calcium levels or a higher leukocyte count.
“The current findings can help shape fatigue-specific screening for associated factors of fatigue in patients with COPD and subsequently link this to management strategies that target these specific factors,” wrote the study authors.
“A more personalised approach when treating fatigue is needed, based on a comprehensive assessment of possible contributing factors of fatigue,” they added, highlighting how “patients with COPD with fatigue and dyspnoea, for example, could benefit from an inhaler drug education programme to reduce dyspnoea, and thereby also fatigue.”