Factors influencing fatigue in patients with COPD include shortness of breath, higher pain levels, poor sleep quality, and fatigue-catastrophizing.

New data found that higher pain levels and poor sleep quality were among the factors that significantly influenced the intensity of fatigue. Other relevant factors were shortness of breath and fatigue-catastrophizing.

The observational FAntasTIGUE study set out to identify contributing factors to the common symptom of fatigue in patients with COPD. The investigation included 260 stable COPD patients, who were managed in either primary or secondary care. Their extent of fatigue as the primary outcome measure was determined using the checklist individual strength-subscale subjective fatigue (CIS-Fatigue). Primarily, an extensive variety of factors that could be impacting fatigue were categorized into 6 different clusters: personal, psychological and symptoms were evaluated by interviews and questionnaires, systemic factors by blood parameters, COPD-related factors by lung function, and physical strength (eg, by muscle strength or frailty). In the first step, separate multivariable stepwise regressions identified potentially influential factors, and these entered a final multivariable regression model that adjusted for age and sex in the second step.

The study cohort was characterized by 60% men with a mean age of 67. Severe fatigue was present in 51% and severe dyspnea in 41%. “The majority of our sample suffered from moderate to severe airflow limitation and about 27% had a high exacerbation risk,” said Maarten Van Herck, at the 2023 ERS International Congress.

The results of the separate cluster models recognized 12 potential factors that could increase fatigue: lower calcium, higher leucocytes, being single, higher Charlson comorbidity index, lower diffusion capacity, more moderate exacerbations within the last year, higher pain, higher dyspnea, worse sleep quality, depressive symptoms, fatigue-catastrophizing and lower functional exercise capacity. Out of these factors, the final model identified four factors with statistical significance: shortness of breath (P=0.004), higher pain levels (P=0.024), lower sleep quality (P=0.009), and fatigue-catastrophizing (P=0.016).

“About 50% of variance of fatigue was explained in our model and future interventions should focus on the treatment of these identified contributing factors of fatigue and assess whether these treatment strategies reduce fatigue in patients with COPD,” Van Herck concluded.

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