The Effect of Fatigue and Fatigue Intensity on Exercise Tolerance in Moderate COPD.

Khaled Al-Shair,Umme Kolsum,Jørgen Vestbo,Dave Singh

doi:10.1007/s00408-016-9931-y

Khaled Al-Shair, Umme Kolsum + Show 2 more

Open Access

https://doi.org/10.1007/s00408-016-9931-y

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Abstract

IntroductionFatigue is one of the most disabling symptoms in COPD, but little is known about the impact of fatigue on functional disability. We explored the impact of fatigue and fatigue intensity on exercise tolerance after adjusting for other factors using multivariate analysis and compared it to that of dyspnoea.MethodsA total of 119 patients with mainly moderate–severe stable COPD (38 % women, mean age 66 years) were enrolled. We used the Medical Research Council dyspnoea scores (MRC), Manchester COPD fatigue scale (MCFS) and its three dimensions, Borg scales for fatigue and dyspnoea, six-minute walk distance (6MWD), St George’s Respiratory Questionnaire, the BODE index, and the Centre for Epidemiological Study on Depression scale (CES-D), and we measured spirometry, blood gases, systemic inflammatory markers and fat-free mass index (FFMI).ResultsFatigue measured using the MCFS was associated with 6MWD and explained 22 % of the variability in 6MWD (p < 0.001). Fatigue remained associated with 6MWD after adjusting for MRC dyspnoea, FFMI and FEV1, FVC, PaO2, PaCO2, CES-D, TNF-alpha, smoking status, age and gender. We found that 33, 50 and 23 % of patients reported an increase by 2 scores on Borg scales for fatigue, dyspnoea or both at the end of the 6MWT. Fatigue scores (both before and after the 6MWT) were negatively correlated with 6MWD after adjusting for FEV1, FFMI, CES-D score and age (p = 0.007 and 0.001, respectively).ConclusionIn moderate stable COPD, fatigue may be a central driver of functional disability, to the same extent as dyspnoea.Electronic supplementary materialThe online version of this article (doi:10.1007/s00408-016-9931-y) contains supplementary material, which is available to authorized users.

Highlights

Fatigue is one of the most disabling symptoms in COPD, but little is known about the impact of fatigue on functional disability
We explored the impact of fatigue and fatigue intensity on exercise tolerance after adjusting for other factors using multivariate analysis and compared it to that of dyspnoea
We used the Medical Research Council dyspnoea scores (MRC), Manchester COPD fatigue scale (MCFS) and its three dimensions, Borg scales for fatigue and dyspnoea, six-minute walk distance (6MWD), St George’s Respiratory Questionnaire, the BODE index, and the Centre for Epidemiological Study on Depression scale (CES-D), and we measured spirometry, blood gases, systemic inflammatory markers and fat-free mass index (FFMI)

Summary

Introduction

Fatigue is one of the most disabling symptoms in COPD, but little is known about the impact of fatigue on functional disability. A limited number of studies have assessed the correlation of fatigue with functional capacity [10], and little is known about the association of fatigue with exercise intolerance using an objective measure such as the selfpaced six-minute walking test (6MWT). Several other factors such as dyspnoea [5, 11], muscle mass depletion [12], age, gender [11], systemic inflammation [13, 14] and global initiative for chronic obstructive lung disease (GOLD) stages and emphysema [5] have been associated with poor performance in the 6MWT.

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