Course of normal and abnormal fatigue in patients with Chronic Obstructive Pulmonary Disease, and its relationship with domains of health status

doi:10.1016/j.pec.2010.08.021

Patient Education and Counseling

Volume 85, Issue 2, November 2011, Pages 281-285

https://doi.org/10.1016/j.pec.2010.08.021 Get rights and content

Abstract

Objective

To examine the difference between patients with normal and patients with abnormal fatigue on aspects of health status, and investigate the natural course of fatigue in patients with Chronic Obstructive Pulmonary Disease (COPD).

Methods

Fatigue, physiological functioning, functional impairment, symptoms, and Quality of Life (QoL) were measured in 168 patients with COPD, and longitudinal data on fatigue of 77 patients were collected.

Results

Fifty percent of patients had abnormal fatigue. Patients with abnormal fatigue reported significantly more problems on the sub-domains of functional impairment (except actual physical activity), symptoms, and QoL as compared to patients with normal fatigue. With respect to physiological functioning patients with normal fatigue scores had better exercise capacity. Four years later the percentage of patients with abnormal fatigue was increased to 64%. In 1/3 of the patients an increase of more than the minimal clinically important difference was found.

Conclusion

Many COPD patients suffer from abnormal fatigue. Patients with abnormal fatigue have more limitations on many aspects of health status, especially on symptoms, functional impairment, and QoL.

Practice implications

Fatigue should be evaluated in usual care with a questionnaire that corrects for normal fatigue in order to tailor treatment to patients’ need.

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a progressive and disabling disease, which is accompanied by a variety of symptoms. In guidelines, dyspnea, cough, and sputum production are marked as key symptoms of COPD [1]. Although not marked as a key symptom, fatigue was reported by patients with COPD as the second most important symptom of COPD, after dyspnea [2], [3], [4].

Of patients with severe COPD 47–58% reported to experience fatigue every day or several days a week [5], [6]. Patients described their fatigue as a feeling of general tiredness [7] and as ‘feeling drained of energy’ [8]. In addition, they reported that the experienced fatigue puts restrictions upon their lives and made them dependent upon others [8]. Patients also reported that the feeling of fatigue was irritating, frustrating [7], and interfered with their ability to concentrate [9].

In the past years, several empirical studies have been performed in which fatigue was merely used as an outcome measure of an intervention [10], [11], [12], [13]. Relatively few studies have studied the relationships between fatigue and many aspects of health status. Some studies showed fatigue to be significantly related to impaired postbronchodilator forced expiratory volume in one second (FEV₁) [14], reduction in exercise capacity [14], and more problems in Quality of Life (QoL) [14], [15]. Moderate, but significant, correlations were found between fatigue on the one hand and anxiety [16] and depression [15], [16] on the other. Correlations of 0.32–0.69 between fatigue and dyspnea have been reported [5], [15], [17], [18]. Other studies did not find significant relationships between fatigue and exercise capacity [16], [19], or FEV₁ [15], [16], [19], [20], [21].

Studies on the natural course of severity of fatigue in patients with COPD using standardized measures are lacking. Besides the fact that fatigue is a highly non-specific symptom and a key symptom in many psychiatric and somatic diseases, fatigue is also a normal phenomenon that healthy persons experience as well. Hence, in determining the severity of fatigue a correction for normal fatigue has to be made.

The aims of the present study are to investigate the prevalence of ‘normal’ and ‘abnormal’ fatigue, and the relationship between fatigue and health status in patients with COPD. In addition, we investigated the natural course of fatigue in COPD.

Section snippets

Participants

One-hundred-sixty-eight COPD patients were recruited from three different pulmonary outpatient clinics in the Netherlands, between May 2002 and May 2003. All patients were diagnosed with COPD [1]. Exclusion criteria were an acute exacerbation, recent (<6 months) participation in pulmonary rehabilitation program, primary comorbidity that may dominate health status, inability to speak or read Dutch, and inability to completely adhere to the research protocol. A detailed description of the

Results

Table 2 shows characteristics of the COPD patients at baseline.

Discussion and conclusion

In the present study, we measured the severity and natural course of fatigue with a standardized questionnaire that corrects for normal fatigue in patients with stable moderate to severe COPD. At baseline, almost half of patients showed abnormal fatigue: 23% mild and 24% severe fatigue. Patients with abnormal fatigue had significantly more limitations in many sub-domains of quality of life, symptoms, and functional impairment than patients with normal fatigue. With respect to physiological

Conflict of interest

None of the authors have any competing interests to declare.

Acknowledgments

We are indebted to F. van den Elshout, MD (pulmonologist, Rijnstate Hospital, Arnhem) and R. Bunnik, MD (pulmonologist, Maas Hospital, Boxmeer) for their contribution to the recruitment of patients. We also are indebted to all participants for their time and effort to contribute to the study.

The study was supported by grants of the Dutch Asthma Foundation, GlaxoSmithKline, the Department of Medical Psychology, the Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, the

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Short communicationCourse of normal and abnormal fatigue in patients with Chronic Obstructive Pulmonary Disease, and its relationship with domains of health status

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Introduction

Section snippets

Participants

Results

Discussion and conclusion

Conflict of interest

Acknowledgments

J Pain Symptom Manage

Br J Dis Chest

J. Obstet Gynecol Neonatal Nurs

Int J Nurs Stud

Int J Nurs Stud

Lancet

Chest

Chest

Chest

Respir Med

Chest

J Psychosom Res

Respir Med

J Psychiat Res

Behav Res Ther

Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

Eur Respir J

Range and severity of symptoms over time among older adults with chronic obstructive pulmonary disease and heart failure

Arch Intern Med

Short communication
Course of normal and abnormal fatigue in patients with Chronic Obstructive Pulmonary Disease, and its relationship with domains of health status