Pulmonary Rehabilitation Reduces Subjective Fatigue in COPD: A Responder Analysis

Abstract

To date, it remains unknown which patients report a clinically-relevant improvement in fatigue following pulmonary rehabilitation (PR). The purpose of this study was to identify and characterize these responders. Demographics, lung function, anxiety (anxiety subscale of the 90-item symptom checklist (SCL-90-A)), depression (Beck depression inventory for primary care (BDI-PC)), exercise tolerance (six-minute walking distance test (6MWD)), and health status (Nijmegen clinical screening instrument (NCSI)) were assessed before and after a 12-week PR programme. Fatigue was assessed using the checklist individual strength (CIS)-Fatigue. Patients with a decline ≥ 10 points (minimally clinically important difference, MCID) on the CIS-Fatigue were defined as responders. Chronic obstructive pulmonary disease (COPD) patients (n = 446, 61 ± 9 years, 53% male, forced expiratory volume in 1 s (FEV1) 43% ± 18% predicted, 75% severe fatigue) were included. Mean change in fatigue after PR was 10 ± 12 points (p < 0.01) and exceeded the MCID. In total, 56% were identified as fatigue responders. Baseline CIS-Fatigue (45 ± 7 vs. 38 ± 9 points, respectively, p < 0.001) and health-related quality-of-life (HRQoL; p < 0.001) were different between responders and non-responders. No differences were found in demographics, baseline anxiety, depression, lung function, 6MWD, and dyspnoea (p-values > 0.01). Responders on fatigue reported a greater improvement in anxiety, depression, 6MWD, dyspnoea (all p-values < 0.001), and most health status parameters. PR reduces fatigue in COPD. Responders on fatigue have worse fatigue and HRQoL scores at baseline, and are also likely to be responders on other outcomes of PR.

Severe Fatigue is Highly Prevalent in Patients with IPF or Sarcoidosis

“…Severe fatigue has been observed frequently in patients with chronic obstructive pulmonary disease (COPD) (ranging between 41 to 75%) [49][50][51], asthma (62%) [52], or cancer survivors (range from 7% to 52%) [53]. The current findings of severe fatigue of 48% and 69% in patients with IPF or sarcoidosis, respectively, fit well.…”

Pulmonary Rehabilitation in Patients with Pulmonary Sarcoidosis: Impact on Exercise Capacity and Fatigue

“…However, results from the multivariate linear regression analysis revealed that only 11% of the changes in V O2peak were explained by the baseline fatigue score. Interestingly, our results were in line with a recent published prospective responder analysis of 446 COPD patients with fatigue following a 12 week interdisciplinary PR program (96).…”

Is it possible to reverse frailty in patients with chronic obstructive pulmonary disease?

“…This extrapulmonary sign is believed to be “the subjective perception of fatigue coupled with exhaustion and a lack of power occurring every day” ( 29 - 31 ). Fatigue is capable of significantly impacting not only the physical but also the mental well-being of patients with COPD, which is usually linked to anxiety, depression, and dyspnea ( 32 , 33 ). A four-year observational study investigating fatigue in patients with COPD confirmed this perspective ( 34 ).…”

“…Investigations have revealed an improvement in fatigue among COPD patients following PR and that this improvement is likely attributed to PR addressing the risk factors that lead to fatigue, such as anxiety, depression, and dyspnea ( 33 ). In a systematic review, three randomized controlled trials (n=269) of comprehensive PR led to reductions in short-term anxiety and depression ( 35 ).…”