Future treatment of fatigue in COPD: 4 possible targets identified

The observational FAntasTIGUE study explored possible causes of fatigue in patients with chronic obstructive pulmonary disease (COPD). Among the most significant influential factors were higher pain levels and poor sleep quality.

“Fatigue is the second most common symptom in patients with COPD next to dyspnoea and it is defined as a subjective unpleasant symptom that can range from tiredness to exhaustion which has an impact on people’s normal functioning,” Dr Maarten Van Herck (Ciro, the Netherlands) described, adding that fatigue is complex and often difficult to treat [1]. He presented the observational FAntasTIGUE study, that identified contributing factors to fatigue in patients with COPD [1]. The study 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 of subjective fatigue (CIS-Fatigue). Primarily, an extensive variety of factors potentially influencing fatigue were categorised into 6 clusters: personal, psychological, and symptomatic factors were evaluated by interviews and questionnaires, systemic factors by blood parameters, COPD-related factors by lung function, and physical strength e.g. by muscle strength or frailty. At first, 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 characterised by a mean age of 67 and 60% were men. Severe fatigue was present in 51% and severe dyspnoea in 41%. “The majority of our cohort suffered from moderate-to-severe airflow limitation and about 27% had a high exacerbation risk,” Dr Van Herck elaborated.
The results of the separate cluster models recognised 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 dyspnoea, worse sleep quality, depressive symptoms, fatigue-catastrophising, and lower functional exercise capacity. Out of these factors, the final model identified 4 factors with statistical significance: shortness of breath (P=0.004), higher pain levels (P=0.024), lower sleep quality (P=0.009), and fatigue-catastrophising (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,” Dr Van Herck concluded.

1. Van Herck M. Contributing factors of fatigue in COPD: results from the FAntasTIGUE study. Abstract 2612, ERS International Congress 2023, 9–13 September, Milan, Italy.

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Posted on 29 October, 202329 October, 2023