1
|
Reid J, Gildea E, Davies V, Thompson J, Scott M. Measuring the effect of the anti-nerve growth factor antibodies bedinvetmab and frunevetmab on quality of life in dogs and cats with osteoarthritis using a validated health-related quality of life outcome measure: an observational real-world study. Front Vet Sci 2024; 11:1395360. [PMID: 39205806 PMCID: PMC11349630 DOI: 10.3389/fvets.2024.1395360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/20/2024] [Indexed: 09/04/2024] Open
Abstract
Background Osteoarthritis causes chronic pain, impaired joint function, decreased mobility and negatively impacts quality of life (QOL). Anti-nerve growth factor antibodies bedinvetmab for dogs and frunevetmab for cats are licensed for the alleviation of osteoarthritis pain but their QOL impact is unreported. Our aim was to determine if these therapeutics improve QOL using a validated health-related QOL measure that generates scores in four domains of QOL-energetic and enthusiastic (E/E), happy and content (H/C), active and comfortable (A/C) and calm and relaxed (C/R)-in the dog and three in the cat-vitality, comfort and emotional wellbeing (EWB). Summary scores for physical wellbeing (PWB) and emotional wellbeing (EWB) for dogs and PWB for cats are calculated from the domain scores. Methods Animals received bedinvetmab (dogs) at 0.5-1 mg/kg or frunevetmab (cats) at 1-2.8 mg/kg by subcutaneous injection on days 0, 28 and 56 and owners completed QOL assessments within 48 hours of day 0 and on days 14, 28, 56, 63 and 70 using a study-specific app. Results Assessments were completed by 75 dog and 56 cat owners. By day 14 there was a statistically significant improvement (p ≤ 0.001) in PWB, EWB and all domains except C/R (p = 0.005) in dogs and in all domains and PWB in the cat. Subsequently there was a continued improvement in all domains and summary scores (p ≤ 0.001) except for H/C in the dog and EWB in the cat, which were excluded from the statistical model. The overall improvement in all domain scores in the cat and E/E and A/C in the dog exceeded the previously reported minimum important difference scores for the QOL measure, indicating a clinically significant change. Conclusion Treatment with bedinvetmab and frunevetmab produced a significant improvement in the QOL of dogs and cats. This latest evidence for the use of these OA pain medications could be helpful in the clinical management of osteoarthritis and post-marketing clinical trials.
Collapse
Affiliation(s)
- Jacqueline Reid
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | - Vinny Davies
- School of Mathematics and Statistics, Glasgow, Glasgow, United Kingdom
| | | | - Marian Scott
- School of Mathematics and Statistics, Glasgow, Glasgow, United Kingdom
| |
Collapse
|
2
|
Jun HS, Kang Y. Factors contributing to chronic obstructive pulmonary disease patients' functional performance: Structural equation modelling based on theory of unpleasant symptoms. Nurs Open 2022; 10:3132-3144. [PMID: 36565154 PMCID: PMC10077362 DOI: 10.1002/nop2.1563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022] Open
Abstract
AIM This study aimed to predict the functional performance of patients with chronic obstructive pulmonary disease by clarifying the relationship among disease severity, uncertainty, social support, symptom experience, coping, and functional performance. DESIGN A model-testing design was used. METHODS The subjects of this study were outpatients with chronic obstructive pulmonary disease who visited the respiratory clinic of a general hospital in Seoul, Korea. The data were collected using validated instruments from July 2018 to April 2019, of which 202 questionnaires in total were used for data analysis. Collected data were analysed by using IBM SPSS v27.0 and Mplus 8.0. RESULTS The severity of the disease, uncertainty, and symptom experience should be reduced to improve the functional performance of chronic obstructive pulmonary disease patients. Furthermore, reduced uncertainty can improve functional performance by reducing symptom experience. Nursing interventions for the improvement of pulmonary function and reduction of symptom experience should be developed.
Collapse
Affiliation(s)
- Hye Suk Jun
- Department of Nursing, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Younhee Kang
- College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea
| |
Collapse
|
3
|
Clark LA, Reed R, Corazzini KN, Zhu S, Renn C, Jennifer Klinedinst N. COPD-Related Fatigue: A Scoping Review. Clin Nurs Res 2022; 32:914-928. [PMID: 36540028 DOI: 10.1177/10547738221141224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Millions of people worldwide have chronic obstructive pulmonary disease (COPD), and one of the most common and troublesome symptoms that must be managed is fatigue. While there are existing interventions to address COPD-related fatigue, not all patients experience benefit. A better understanding of the factors associated with COPD-fatigue could elucidate new approaches to address COPD-related fatigue, thereby offering relief to a greater number of patients. The purpose of this review was to identify the physiologic, psychologic, and situational factors associated with COPD-related fatigue. A total of four databases, PubMed, CINAHL, Scopus, and Google Scholar, were searched. Those that were peer reviewed, in English, and published between 2000 and 2021, were included in the review. A total of 25 articles were included in this scoping review. The following factors were related to fatigue in COPD: dyspnea, pain, anxiety, depression, and sleep. Fatigue is a debilitating symptom with factors influential to the symptom and outcomes. Research is indicated to explore targeted and personalized interventions addressing the factors related to fatigue to mitigate this widespread symptom.
Collapse
Affiliation(s)
- Lindsey A. Clark
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Robert Reed
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Cynthia Renn
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | | |
Collapse
|
4
|
Assaf EA, Badarneh A, Saifan A, Al-Yateem N. Chronic obstructive pulmonary disease patients' quality of life and its related factors: A cross-sectional study of the Jordanian population. F1000Res 2022; 11:581. [PMID: 35811805 PMCID: PMC9237555 DOI: 10.12688/f1000research.121783.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death globally, mostly in low- and middle-income countries. It is estimated that 6.5% of Jordanians under 50 and 37.5% of those over 70 years of age are affected. The country's air pollution levels surpass recommended levels, increasing the disease incidence and burden on individuals and the health system. COPD is a long-term, severe, and exhausting condition. In Jordan, patients are highly dependent and frequent users of the healthcare services; therefore, their Quality of Life (QoL) is highly influenced by the health care they receive. The QoL of COPD patients must be studied to devise interventions that can help patients cope with this disease and for healthcare systems to improve their service. Method: A cross-sectional correlational study of 200 COPD patients. The Arabic WHO Quality of Life Questionnaire Short Form was used to collect data. Results: The mean COPD patient QoL score was 10.66 (SD=1.58), showing poor QoL perception. The physical domain had the lowest perceived QoL (10.232, SD=1.912), while the environmental domain had the highest (10.948, SD=1.636). Unmarried, non-smokers, and employed had better QoL (M=11.04, M=10.92, M=12.04). Age categories 50-61 exhibited greater mean QoL than age category 61 or higher (M=11.44, M=10.84, M=10.08). Private health services are characterized by short waiting times, availability of different diagnostic and treatment services, and skilled staff was related to better QoL. Conclusions: QoL for COPD patients seems to be an area requiring urgent attention from Health service providers and planners. Patients should be adequately supported and cared for to have a good QoL. In Jordan, COPD patients' QoL is highly influenced by lack of physical activity, emotional distress, and anxiety. Therefore, better health care services is needed to address all these areas adequately.
Collapse
Affiliation(s)
- Enas A Assaf
- Faculty of Nursing, Applied Science Private University, Amman, 11931, Jordan
| | - Angham Badarneh
- Department Of Nursing, - Prince Hamza Hospital, Amman, 11224, Jordan
| | - Ahmad Saifan
- Faculty of Nursing, Applied Science Private University, Amman, 11931, Jordan
| | - Nabeel Al-Yateem
- College of Health Sciences, Department of Nursing, University fo Sharjah, Sharjah, 27272, United Arab Emirates
| |
Collapse
|
5
|
The Effect of Dyspnea and Fatigue on Sexual Life and Marital Satisfaction in Individuals With Chronic Obstructive Pulmonary Disease. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Wang L, Guo Y, Liu Y, Yan X, Ding R, Huang S. Prevalence of fatigue and associated factors among clinically stable patients with chronic obstructive pulmonary disease in Guizhou, China: A cross-sectional study. CLINICAL RESPIRATORY JOURNAL 2021; 15:1239-1247. [PMID: 34331417 DOI: 10.1111/crj.13432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Fatigue is important, but ignored symptom among COPD patients. At present, there is very limited data are available for the prevalence of fatigue and its risk factors among COPD patients in China. OBJECTIVE The purpose of this study is to determine the prevalence of fatigue and to investigate the factors associated with fatigue among clinically stable patients with COPD in China. METHODS This is a cross-sectional study using a questionnaire to collect data on sociodemographic, related to COPD disease, and exercise habits. Multidimensional fatigue inventory (MFI-20) was used to assess the prevalence of fatigue. Independent samples t test, bivariate correlation, one-way ANOVA test, and test for several independent samples were used to compare the sociodemographic factors with MFI-20 scores of COPD patients. Multiple stepwise linear regression was performed to estimate influencing factors related to the MFI-20 of COPD patients. RESULTS Among the participants, the prevalence of fatigue was 88.62%. Negative correlations were found between FEV1% and multidimensional fatigue (r = -0.40, p < 0.01), general fatigue (r = -0.20, p < 0.05), reduced activity (r = -0.20, p < 0.01), and physical fatigue (r = -0.10, p < 0.01). A multiple linear regression models revealed that age (p < 0.05), BMI (p < 0.05), FEV1 % (p < 0.01), exercise times (p < 0.01), and the times of hospitalization in the past 12 months (p < 0.05) were associated with multidimensional fatigue scores. CONCLUSIONS The prevalence of fatigue is high among clinically stable patients with COPD. Keeping exercise, prevention obesity, and exacerbation should be an effective intervention strategy to reduce COPD-related fatigue.
Collapse
Affiliation(s)
- LianHong Wang
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,Nursing Department, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yunmei Guo
- Nursing Department, Zunyi Medical University, Zunyi, Guizhou, China
| | - Ying Liu
- Nursing Department, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xin Yan
- Nursing Department, Zunyi Medical University, Zunyi, Guizhou, China
| | - Rui Ding
- Nursing Department, Zunyi Medical University, Zunyi, Guizhou, China
| | - Shiming Huang
- Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| |
Collapse
|
7
|
Szymanska-Chabowska A, Juzwiszyn J, Tański W, Świątkowski F, Kobecki J, Chabowski M. The fatigue and quality of life in patients with chronic pulmonary diseases. Sci Prog 2021; 104:368504211044034. [PMID: 34541942 PMCID: PMC10359652 DOI: 10.1177/00368504211044034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with pulmonary diseases often experience fatigue. Severe fatigue is associated with a worse health status and worse physical and social functioning. The study aimed to evaluate the relationship between fatigue and quality of life in patients with nonmalignant pulmonary diseases. METHODS The St George's Respiratory Questionnaire (SGRQ) was used to assess health status and the Fatigue Impact Scale (MFIS) to measure the level of fatigue. The Shapiro-Wilk test was used to test for normal distribution. Correlations were described as Spearman's rank correlation coefficient. RESULTS The study included 200 consecutive patients (mean age, 57.7) with the following diagnoses: COPD (26%), asthma (36%), obstructive sleep apnoea (19%), pneumonia or bronchitis of various aetiologies (8.5%), bronchiectasis (2.5%), interstitial lung disease (3%). The mean score in the SGRQ was 44.62 ± 24.94. The mean score in the MFIS was 28.64 ± 15.8. The strongest correlations appeared between quality-of-life scales and fatigue as measured by physical functioning (symptoms r = 0.622; activity r = 0.632; impact r = 0.692; p < 0.001 for all subscales); however, all the correlations between SGRQ and MFIS were significant. CONCLUSIONS Patients with chronic pulmonary diseases were revealed to have a reduced level of quality of life and an increased level of fatigue. The negative influence of fatigue on quality of life highlights the need for careful and routine assessment of this symptom in pulmonary patients. Treating fatigue may improve quality of life and increase the ability of patients with chronic pulmonary diseases to perform activities in daily life.
Collapse
Affiliation(s)
- Anna Szymanska-Chabowska
- Department of Internal Medicine,
Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Poland
| | - Jan Juzwiszyn
- Division of Nervous System Diseases,
Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical
University, Poland
| | - Wojciech Tański
- Department of Internal Medicine, 4th Military Teaching
Hospital, Wrocław, Poland
| | - Filip Świątkowski
- Division of Oncology and Palliative
Care, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical
University, Wroclaw, Dolnoslaskie, Poland
- Department of Surgery, 4th Military
Teaching Hospital, Wroclaw, Poland
| | - Jakub Kobecki
- Division of Oncology and Palliative
Care, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical
University, Wroclaw, Dolnoslaskie, Poland
- Department of Surgery, 4th Military
Teaching Hospital, Wroclaw, Poland
| | - Mariusz Chabowski
- Division of Oncology and Palliative
Care, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical
University, Wroclaw, Dolnoslaskie, Poland
- Department of Surgery, 4th Military
Teaching Hospital, Wroclaw, Poland
| |
Collapse
|
8
|
Antoniu SA, Boiculese LV, Prunoiu V. Frailty, a Dimension of Impaired Functional Status in Advanced COPD: Utility and Clinical Applicability. ACTA ACUST UNITED AC 2021; 57:medicina57050474. [PMID: 34064756 PMCID: PMC8150879 DOI: 10.3390/medicina57050474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: In advanced chronic obstructive pulmonary disease (COPD), functional status is significantly impaired mainly as a result of disease related respiratory symptoms such as dyspnea or as a result of fatigue, which is the extra-respiratory symptom the most prevalent in this setting. "Physical" frailty, considered to be an aging phenotype, has defining traits that can also be considered when studying impaired functional status, but little is known about this relationship in advanced COPD. This review discusses the relevance of this type of frailty in advanced COPD and evaluates it utility and its clinical applicability as a potential outcome measure in palliative care for COPD. Materials and Methods: A conceptual review on the functional status as an outcome measure of mortality and morbidity in COPD, and an update on the definition and traits of frailty. Results: Data on the prognostic role of frailty in COPD are rather limited, but individual data on traits of frailty demonstrating their relationship with mortality and morbidity in advanced COPD are available and supportive. Conclusions: Frailty assessment in COPD patients is becoming a relevant issue not only for its potential prognostic value for increased morbidity or for mortality, but also for its potential role as a measure of functional status in palliative care for advanced COPD.
Collapse
Affiliation(s)
- Sabina Antonela Antoniu
- Department of Medicine II and L Boiculese, Department of Interdisciplinary Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania;
- Correspondence: or
| | - Lucian Vasile Boiculese
- Department of Medicine II and L Boiculese, Department of Interdisciplinary Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania;
| | - Virgiliu Prunoiu
- Department 10 Surgery, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania;
| |
Collapse
|
9
|
Ebadi Z, Goërtz YMJ, Van Herck M, Janssen DJA, Spruit MA, Burtin C, Thong MSY, Muris J, Otker J, Looijmans M, Vlasblom C, Bastiaansen J, Prins J, Wouters EFM, Vercoulen JH, Peters JB. The prevalence and related factors of fatigue in patients with COPD: a systematic review. Eur Respir Rev 2021; 30:30/160/200298. [PMID: 33853886 DOI: 10.1183/16000617.0298-2020] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/04/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Fatigue is a distressing symptom in patients with COPD. Little is known about the factors that contribute to fatigue in COPD. This review summarises existing knowledge on the prevalence of fatigue, factors related to fatigue and the instruments most commonly used to assess fatigue in COPD. METHODS Pubmed, PsycINFO, EMBASE, Cochrane and CINAHL databases were searched for studies from inception up to 7 January 2020 using the medical subject headings "COPD" and "Fatigue". Studies were reviewed in accordance with PRISMA guidelines. RESULTS 196 studies were evaluated. The prevalence of fatigue ranged from 17-95%. Age (r=-0.23 to r=0.27), sex (r=0.11), marital status (r=-0.096), dyspnoea (r=0.13 to r=0.78), forced expiatory volume in 1 s % predicted (r=-0.55 to r=-0.076), number of exacerbations (r=0.27 to r=0.38), number of comorbidities (r=0.10), number of medications (r=0.35), anxiety (r=0.36 to r=0.61), depression (r=0.41 to r=0.66), muscle strength (r=-0.78 to r=-0.45), functional capacity (r=-0.77 to r=-0.14) and quality of life (r=0.48 to r=0.77) showed significant associations with fatigue. CONCLUSIONS Fatigue is a prevalent symptom in patients with COPD. Multiple physical and psychological factors seem to be associated with fatigue. Future studies are needed to evaluate these underlying factors in integral analyses in samples of patients with COPD.
Collapse
Affiliation(s)
- Zjala Ebadi
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Joint first authors
| | - Yvonne M J Goërtz
- Dept of Research and Development, Ciro, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Joint first authors
| | - Maarten Van Herck
- Dept of Research and Development, Ciro, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Daisy J A Janssen
- Dept of Research and Development, Ciro, Horn, The Netherlands.,Dept of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martijn A Spruit
- Dept of Research and Development, Ciro, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Melissa S Y Thong
- Dept of Medical Psychology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Jean Muris
- Dept of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Milou Looijmans
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Christel Vlasblom
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joëlle Bastiaansen
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Judith Prins
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Emiel F M Wouters
- Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Jan H Vercoulen
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jeannette B Peters
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Souron R, Morel J, Gergelé L, Infantino P, Brownstein CG, Lapole T, Millet GY. Relationship between intensive care unit-acquired weakness, fatigability and fatigue: What role for the central nervous system? J Crit Care 2020; 62:101-110. [PMID: 33316555 DOI: 10.1016/j.jcrc.2020.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To provide a comprehensive review of studies that have investigated fatigue in intensive care unit (ICU) survivors and questions the potential link between intensive care unit-acquired weakness (ICUAW), fatigability and fatigue. We also question whether the central nervous system (CNS) may be the link between these entities. MATERIAL AND METHODS A narrative review of the literature that investigated fatigue in ICU survivors and review of clinical trials enabling understanding of CNS alterations in response to ICU stays. RESULTS Fatigue is a pervasive and debilitating symptom in ICU survivors that can interfere with rehabilitation. Due to the complex pathophysiology of fatigue, more work is required to understand the roles of ICUAW and/or fatigability in fatigue to provide a more holistic understanding of this symptom. While muscle alterations have been well documented in ICU survivors, we believe that CNS alterations developing early during the ICU stay may play a role in fatigue. CONCLUSIONS Fatigue should be considered and treated in ICU survivors. The causes of fatigue are likely to be specific to the individual. Understanding the role that ICUAW and fatigability may have in fatigue would allow to tailor individual treatment to prevent this persistent symptom and improve quality of life.
Collapse
Affiliation(s)
- Robin Souron
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France; Laboratory of Impact of Physical Activity on Health (IAPS), UR n°201723207F, University of Toulon, France
| | - Jérôme Morel
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France; Département d'anesthésie et réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France.
| | - Laurent Gergelé
- Ramsay Générale de Santé, Hôpital privé de la Loire, Saint Etienne, France
| | - Pascal Infantino
- Département d'anesthésie et réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Callum G Brownstein
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France.
| | - Thomas Lapole
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France
| | - Guillaume Y Millet
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France.
| |
Collapse
|
11
|
Zhou Z, Zhou A, Peng Y, Duan J, Zeng Y, Zhao Y, Cheng W, Chen P. Determinants of Clinical COPD Questionnaire in Patients with COPD: A Cross-Sectional Observational Study. Respiration 2020; 99:606-616. [PMID: 32659763 DOI: 10.1159/000507097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Clinical COPD Questionnaire (CCQ) has been suggested by the Global Initiative of Chronic Obstructive Lung Disease (GOLD) as a comprehensive symptom measurement tool, which helps to classify patients in order to direct pharmacological treatment. Therefore, it is essential to understand its determinants. OBJECTIVES To identify the determinants of the overall CCQ score and scores of its 3 subdomains among chronic obstructive pulmonary disease (COPD) patients from China. METHODS A total of 1,241 COPD patients in the outpatient department of the Second Xiangya Hospital in China were recruited. Basic information and clinical data were collected. Differences in the GOLD categories based on Modified Medical Research Council Dyspnea Scale (mMRC), COPD Assessment Test (CAT), and CCQ were compared. Multiple linear regression analyses were performed to evaluate determinant factors of the total CCQ and subdomain scores. RESULTS The total CCQ and/or separate domain scores significantly differed with sex, age, BMI, smoking status, biomass fuel exposure, exacerbation frequency, mMRC, CAT, and GOLD grades and groups. Subjects with asthma-COPD overlap (ACO) had worse health status based on CCQ than those with COPD alone. As for the 16 subgroups based on GOLD 2017, statistical differences in the total CCQ and functional domain scores were found among subgroups 1A-4A, 1B-4B, and 1D-4D. The mMRC classified much more patients into more symptom groups than CAT and CCQ. No significant difference was observed in the GOLD categories between the CAT and CCQ (cut point = 1.5). Multiple linear regression analysis showed that smoking status, underweight, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were independently associated with the total CCQ score. Only 3 variables were significantly associated with the symptom domain: ACO, exacerbations, and mMRC; for the functional domain, age ≥75 years, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were significant; female sex, underweight, frequent exacerbations (≥2), and mMRC were significantly associated with higher scores in the mental domain. CONCLUSIONS The classification of COPD produced by mMRC, CAT, and CCQ was not identical. Smoking status, underweight, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were associated with lower health-related quality of life assessed by the total CCQ score, while different subdomains of CCQ had different determinant factors.
Collapse
Affiliation(s)
- Zijing Zhou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Aiyuan Zhou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Yating Peng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Jiaxi Duan
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Yuqin Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Yiyang Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Wei Cheng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Research Unit of Respiratory Disease, Central South University, Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China,
| |
Collapse
|
12
|
Yang Y, Li Q, Mao J, Mao Z. Fatigue and health‐related quality of life among patients with chronic obstructive pulmonary disease in China. CLINICAL RESPIRATORY JOURNAL 2019; 14:109-115. [DOI: 10.1111/crj.13107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ying Yang
- School of Health Sciences Wuhan University Wuhan China
- School of Nursing Tongji Medical College Huazhong University of Science & Technology Wuhan China
| | - Qianqiu Li
- Department of Cardiovascular Surgery Union Hospital Tongji Medical College Huazhong University of Science & Technology Wuhan China
| | - Jing Mao
- School of Nursing Tongji Medical College Huazhong University of Science & Technology Wuhan China
| | - Zongfu Mao
- School of Health Sciences Wuhan University Wuhan China
- Global Health Institute Wuhan University Wuhan China
| |
Collapse
|
13
|
Antoniu SA, Apostol A, Boiculese LV. Extra‐respiratory symptoms in patients hospitalized for a COPD exacerbation: Prevalence, clinical burden and their impact on functional status. CLINICAL RESPIRATORY JOURNAL 2019; 13:735-740. [DOI: 10.1111/crj.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Sabina Antonela Antoniu
- Department of Medicine II‐Nursing/Palliative Care University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| | - Anca Apostol
- Faculty of Medicine University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| | - Lucian Vasile Boiculese
- Department of Interdisciplinarity‐Biostatistics University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| |
Collapse
|
14
|
Gruet M. Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation. Front Physiol 2018; 9:1285. [PMID: 30283347 PMCID: PMC6156387 DOI: 10.3389/fphys.2018.01285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.
Collapse
|
15
|
Franssen FME, Smid DE, Deeg DJH, Huisman M, Poppelaars J, Wouters EFM, Spruit MA. The physical, mental, and social impact of COPD in a population-based sample: results from the Longitudinal Aging Study Amsterdam. NPJ Prim Care Respir Med 2018; 28:30. [PMID: 30097575 PMCID: PMC6086825 DOI: 10.1038/s41533-018-0097-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/10/2018] [Accepted: 07/19/2018] [Indexed: 12/31/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with substantial health impact that may already become apparent in early disease. This study aims to examine the features of subjects with COPD in a Dutch population-based sample and compare their physical status, mental status, and social status to non-COPD subjects. This study made use of Longitudinal Aging Study Amsterdam (LASA) data. Demographics, clinical characteristics, self-reported diseases, post-bronchodilator spirometry, physical, mental, and social status were assessed. A number of 810 subjects (50.5% male, mean age 60.5 ± 2.9 years) were included. Subjects with COPD (n = 68, mean FEV1 67.6 [IQR 60.4–80.4] %.) had a slower walking speed than non-COPD subjects, p = 0.033. When compared to non-COPD subjects, COPD subjects gave a lower rating on their health (physical subscale of SF-12: 15 [IQR 16.0–19.0] vs. 18 [IQR 11.0–17.0] points) and life (EQ5D VAS: 75 [IQR 70.0–90.0] vs. 80 points [IQR 65.0–85.5]) surveys. COPD subjects also had a more impaired disease-specific health status (CAT: 9.5 ± 5.9 vs. 6.7 ± 5.2, respectively), were less likely to have a partner (69% vs. 84%, respectively) and received emotional support less often (24% vs. 36%, respectively) compared to non-COPD subjects (All comparisons p < 0.001). In a population-based sample, subjects with COPD had a reduced physical performance, a more impaired disease-specific health status and were more socially deprived compared to non-COPD subjects. These impairments need to be taken into consideration when setting up a management program for patients with mild COPD. Patients with early-stage chronic lung disease need holistic support to limit the physical, mental and social impacts of the condition. There is more to chronic obstructive pulmonary disease (COPD) than persistent airflow limitation; systemic effects, including loss of muscle strength and higher risk of heart conditions, mental health and social problems can manifest from the early stages. Frits Franssen at CIRO, the Netherlands, and co-workers interviewed 810 participants aged 55–65 from the Longitudinal Aging Study Amsterdam to investigate the physical, mental and social status of COPD sufferers and compare them with healthy controls. Those with COPD were more likely to walk slower, tire easily and perceive themselves as having poor overall health. Socially, COPD patients were less likely to have long-term partners and felt the need for more emotional support than their healthy peers.
Collapse
Affiliation(s)
- Frits M E Franssen
- Department of Research & Education, CIRO, Horn, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands. .,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Dionne E Smid
- Department of Research & Education, CIRO, Horn, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology & Biostatistics, EMGO+Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Biostatistics, EMGO+Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Jan Poppelaars
- Department of Epidemiology & Biostatistics, EMGO+Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
16
|
Antohe I, Antoniu SA, Gavrilovici C. Triple fixed inhaled therapy in frequent chronic obstructive pulmonary disease exacerbators: potential advantages for various degrees of airways obstruction. Expert Opin Pharmacother 2017; 19:287-289. [PMID: 29271268 DOI: 10.1080/14656566.2017.1419186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Inhaled therapies are the therapeutic mainstay in stable chronic obstructive pulmonary disease (COPD). They are represented by long-acting bronchodilators (anticholinergics or beta2-agonists) and by inhaled corticosteroids, currently available as a monotherapy or as combination therapies in one inhaler. Combinations of anticholinergics and beta2 agonists or beta2 agonists and inhaled corticosteroids are widely used per the prescription guidelines. The advantage of them are related with higher adherence and better acceptability by the patients as compared to both components dosed with individual inhalers. Bronchodilator combinations have also been demonstrated to exhibit a superior efficacy due to their synergistic mechanism of action when compared to either monotherapy. Triple therapies with anticholinergic-beta2 agonist-inhaled corticosteroid have been under investigation over the last few years and recently one such product became available in the EU for the treatment of stable COPD. Areas covered: The the FULFIL trial (Lung FUnction and quality of LiFe assessment in COPD with closed trIpLe therapy) investigated the efficacy and safety of fluticasone/vilanterol/umeclidinium once daily therapy in COPD patients. Expert opinion: The results discussed in this paper support the use of this combination in advanced COPD but also in earlier stages in patients with frequent exacerbation. However further and more long-term assessments are required.
Collapse
Affiliation(s)
- Ileana Antohe
- a Department Medicine II-Nursing , University of Medicine and Pharmacy Grigore T Popa , Iasi , Romania
| | - Sabina A Antoniu
- a Department Medicine II-Nursing , University of Medicine and Pharmacy Grigore T Popa , Iasi , Romania
| | - Cristina Gavrilovici
- b Department Medicine III-Bioethics , University of Medicine and Pharmacy Grigore T Popa , Iasi , Romania
| |
Collapse
|
17
|
Zhou Z, Zhou A, Zhao Y, Chen P. Evaluating the Clinical COPD Questionnaire: A systematic review. Respirology 2017; 22:251-262. [PMID: 28102972 DOI: 10.1111/resp.12970] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022]
Abstract
The Clinical COPD Questionnaire (CCQ) is recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to evaluate health status in patients with COPD. The objective of this work was to systemically assess the reliability, validity, responsiveness and minimum clinically important difference (MCID) of the CCQ. A structured search was conducted in three databases to identify articles that evaluated the psychometric properties of the CCQ in individuals with COPD. Two investigators screened the title, abstract and full text of the articles to determine study eligibility and performed the data extraction. Quality assessment of included studies was assessed by the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) checklist. Finally, 43 studies were included, over half of which had fair methodological quality. Internal consistency (reliability) of the CCQ total score ranged from 0.84 to 0.94, and test-retest reliability was 0.70-0.99. The overall CCQ had a better correlation with St George's Respiratory Questionnaire (SGRQ; from 0.71 to 0.88) and COPD Assessment Test (CAT; from 0.64 to 0.88) than modified Medical Research Council (mMRC; from 0.392 to 0.668) and forced expiratory volume in 1 s (FEV1 % predicted; from -0.31 to -0.68). Scores were different within GOLD stages, groups, composite events and co-morbidities. CCQ was sensitive to exacerbations, pulmonary rehabilitation and smoking cessation with the MCID of 0.4. The CCQ is a very useful and practical tool that can be used in clinical populations with good reliability, validity and responsiveness to interventions.
Collapse
Affiliation(s)
- Zijing Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Aiyuan Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiyang Zhao
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping Chen
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
18
|
van den Akker EFMM, Van't Hul AJ, Birnie E, Chavannes NH, Rutten-van Mölken MPMH, In't Veen JCCM. Comprehensive Diagnostic Assessment of Health Status of Patients with Asthma or COPD: A Delphi Panel Study among Dutch Experts. COPD 2016; 14:190-199. [PMID: 28026983 DOI: 10.1080/15412555.2016.1264378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A comprehensive diagnostic assessment is needed to improve understanding of the health status of patients with chronic obstructive pulmonary disease (COPD) or asthma. Therefore, this study investigated which components and subsequent instruments should be part of a holistic assessment in secondary care. We also explored which data need to be exchanged for an adequate transfer of patients between primary and secondary care, and vice versa. A cross-sectional Web-based survey was conducted among Dutch healthcare professionals using a Delphi-like procedure; these included professionals working in primary or secondary care, medical advisors of health insurance companies and patients' representatives. The national guidelines were used as a starting point, resulting in a questionnaire addressing 55 components related to a comprehensive diagnostic assessment, covering the domains physiological impairments, symptoms, functional limitations and quality of life. Of the 151 experts and stakeholders invited, 92 (60.9%) completed the first round and 79 (52.3%) the second round; most respondents were pulmonologists. There was a high level of agreement between respondents from primary versus secondary care regarding which components should be measured during a comprehensive assessment of patients with asthma or COPD in secondary care and the instruments to measure these components. Regarding the exchange of information, upon referral, pulmonologists required little information from the general practitioners, whereas general practitioners required more extensive information after referral. An overview is provided of what should be part of a holistic assessment of health status in asthma and COPD. This information can be used as input for integrated care pathways.
Collapse
Affiliation(s)
- Edmée F M M van den Akker
- a Department of Pulmonary Diseases , STZ Centre of Excellence for Asthma and COPD, Franciscus Gasthuis and Vlietland , Rotterdam , The Netherlands
| | - Alex J Van't Hul
- b Department of Pulmonary Diseases , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Erwin Birnie
- c Department of Education and Statistics , Franciscus Academy, Franciscus Gasthuis and Vlietland , Rotterdam , The Netherlands.,d Division of Women and Baby , Department of Obstetrics and Gynaecology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Niels H Chavannes
- e Department of Public Health and Primary Care , Leiden University Medical Centre , Leiden , The Netherlands
| | - Maureen P M H Rutten-van Mölken
- f Institute of Health Care Policy and Management/Institute of Medical Technology Assessment, Erasmus University Rotterdam , Rotterdam , The Netherlands
| | - Johannes C C M In't Veen
- a Department of Pulmonary Diseases , STZ Centre of Excellence for Asthma and COPD, Franciscus Gasthuis and Vlietland , Rotterdam , The Netherlands
| |
Collapse
|
19
|
Kentson M, Tödt K, Skargren E, Jakobsson P, Ernerudh J, Unosson M, Theander K. Factors associated with experience of fatigue, and functional limitations due to fatigue in patients with stable COPD. Ther Adv Respir Dis 2016; 10:410-24. [PMID: 27591046 PMCID: PMC5933621 DOI: 10.1177/1753465816661930] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the influence of selected physiological, psychological and situational factors on experience of fatigue, and functional limitations due to fatigue in patients with stable chronic obstructive pulmonary disease (COPD). METHODS In total 101 patients with COPD and 34 control patients were assessed for experience of fatigue, functional limitation due to fatigue (Fatigue Impact Scale), physiological [lung function, 6-minute walk distance (6MWD), body mass index (BMI), dyspnoea, interleukin (IL)-6, IL-8, high sensitivity C-reactive protein (hs-CRP), surfactant protein D], psychological (anxiety, depression, insomnia), situational variables (age, sex, smoking, living alone, education), and quality of life. RESULTS Fatigue was more common in patients with COPD than in control patients (72% versus 56%, p < 0.001). Patients with COPD and fatigue had lower lung function, shorter 6MWD, more dyspnoea, anxiety and depressive symptoms, and worse health status compared with patients without fatigue (all p < 0.01). No differences were found for markers of systemic inflammation. In logistic regression, experience of fatigue was associated with depression [odds ratio (OR) 1.69, 95% confidence interval (CI) 1.28-2.25) and insomnia (OR 1.75, 95% CI 1.19-2.54). In linear regression models, depression, surfactant protein D and dyspnoea explained 35% (R(2)) of the variation in physical impact of fatigue. Current smoking and depression explained 33% (R(2)) of the cognitive impact of fatigue. Depression and surfactant protein D explained 48% (R(2)) of the psychosocial impact of fatigue. CONCLUSIONS Experiences of fatigue and functional limitation due to fatigue seem to be related mainly to psychological but also to physiological influencing factors, with depressive symptoms, insomnia problems and dyspnoea as the most prominent factors. Systemic inflammation was not associated with perception of fatigue but surfactant protein D was connected to some dimensions of the impact of fatigue.
Collapse
Affiliation(s)
- Magnus Kentson
- Department of Medicine, Division of Pulmonology, Ryhov County Hospital, Jönköping, Sweden, S-551 85 Jönköping, Sweden and Department of Medical and Health Sciences, Linköping University, S-581 83 Linköping, Sweden
| | - Kristina Tödt
- Department of Respiratory Medicine, Linköping University, Linköping, Sweden and Department of Respiratory Medicine & Allergology, Skane University Hospital, Lund, Sweden
| | - Elisabeth Skargren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Per Jakobsson
- Department of Medicine, Division of Pulmonology, Ryhov County Hospital, Jönköping, Sweden
| | - Jan Ernerudh
- Department of Clinical Immunology and Transfusion Medicine, Clinical Immunology, Linköping, Sweden
| | - Mitra Unosson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Kersti Theander
- Faculty of Health, Science and Technology, Department of Health Sciences, Nursing, Karlstad University and Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden
| |
Collapse
|