Abstract
The 2018 update of the Global Strategy for Asthma Management and Prevention does not mention fatigue-related symptoms. Nevertheless, patients with asthma frequently report tiredness, lack of energy, and daytime sleepiness. Quantitative research regarding the prevalence of fatigue in asthmatic patients is lacking. This retrospective cross-sectional study of outpatients with asthma upon referral to a chest physician assessed fatigue (Checklist Individual Strength-Fatigue (CIS-Fatigue)), lung function (spirometry), asthma control (Asthma Control Questionnaire (ACQ)), dyspnea (Medical Research Council (MRC) scale), exercise capacity (six-minute walk test (6MWT)), and asthma-related Quality-of-Life (QoL), Asthma Quality of Life Questionnaire (AQLQ) during a comprehensive health-status assessment. In total, 733 asthmatic patients were eligible and analyzed (47.4 ± 16.3 years, 41.1% male). Severe fatigue (CIS-Fatigue ≥ 36 points) was detected in 62.6% of patients. Fatigue was not related to airflow limitation (FEV1, ρ = −0.083); was related moderately to ACQ (ρ = 0.455), AQLQ (ρ = −0.554), and MRC (ρ = 0.435; all p-values < 0.001); and was related weakly to 6MWT (ρ = −0.243, p < 0.001). In stepwise multiple regression analysis, 28.9% of variance in fatigue was explained by ACQ (21.0%), MRC (6.5%), and age (1.4%). As for AQLQ, 42.2% of variance was explained by fatigue (29.8%), MRC (8.6%), exacerbation rate (2.6%), and age (1.2%). Severe fatigue is highly prevalent in asthmatic patients; it is an important determinant of disease-specific QoL and a crucial yet ignored patient-related outcome in patients with asthma.
Highlights
Wheezing, breathlessness, chest tightness, and cough are cardinal symptoms in patients with asthma
Qualitative research suggested that patients with asthma suffer from fatigue [2,3], which was quantified by Peters and colleagues who identified severe fatigue in 90% of their sample of patients referred to tertiary-care using the Checklist Individual Strength-Fatigue (CIS)-Fatigue [6]
The current findings suggest that fatigue must be assessed and handled in primary and secondary asthma care, whereas fatigue is an important determinant of patient-reported, disease-specific quality of life (QoL)
Summary
Breathlessness, chest tightness, and cough are cardinal symptoms in patients with asthma. These symptoms vary over time and are often triggered by exercise, emotions, dust, and/or exposure to allergens [1]. In addition to these well-known respiratory symptoms, asthmatic patients report that they experience tiredness [2,3], lack of energy [3], and daytime sleepiness [4]. Fatigue, defined as the subjective feeling of tiredness or exhaustion [5], may be a common and clinically relevant symptom in asthmatic patients. The prevalence of severe fatigue and its association with clinically relevant features in a broader, more general sample of patients with asthma remains unknown
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