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. 2018 Nov 23;7(12):471.
doi: 10.3390/jcm7120471.

Fatigue is Highly Prevalent in Patients with Asthma and Contributes to the Burden of Disease

Maarten Van Herck  1   2 , Martijn A Spruit  3   4   5   6 , Chris Burtin  7 , Remco Djamin  8 , Jeanine Antons  9 , Yvonne M J Goërtz  10 , Zjala Ebadi  11 , Daisy J A Janssen  12   13 , Jan H Vercoulen  14 , Jeannette B Peters  15 , Melissa S Y Thong  16 , Jacqueline Otker  17 , Arnold Coors  18 , Mirjam A G Sprangers  19 , Jean W M Muris  20 , Emiel F M Wouters  21   22 , Alex J van 't Hul  23
Affiliations

Fatigue is Highly Prevalent in Patients with Asthma and Contributes to the Burden of Disease

Maarten Van Herck et al. J Clin Med. .

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.

Keywords: asthma; fatigue; quality of life.

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Conflict of interest statement

All authors (with the exception of M.A.S. and D.J.A.J.) have nothing to disclose. D.J.A.J. reports personal fees from Novartis, AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline outside the submitted work. M.A.S. reports grants from AstraZeneca, Boehringer Ingelheim, Netherlands Lung Foundation, and Stichting Astma Bestrijding during the conduct of the study; and personal fees from AstraZeneca, Boehringer Ingelheim, Novartis, Teva, and GlaxoSmithKline outside the submitted work.

Figures

Figure 1
Figure 1
Flowchart of participants’ inclusion. n: number of subjects.
Figure 2
Figure 2
Proportion of asthmatic patients with normal/mild dyspnea (MRC < 3) or severe dyspnea (MRC ≥ 3) after stratification for the degree of fatigue. A statistically significant association between degree of fatigue and degree of dyspnea was observed, χ2 (2, n = 532) = 56.229, V = 0.325, and p < 0.001. MRC: Medical Research Council; n: number of subjects; V: Cramer’s V.
Figure 3
Figure 3
Proportion of asthmatic patients with controlled (ACQ ≤ 0.75), partially controlled (ACQ 0.76–1.49), and uncontrolled asthma (ACQ ≥ 1.5) after stratification for the degree of fatigue. A statistically significant association between degree of fatigue and degree of asthma control was observed; χ2 (4, n = 664) = 93.073, V = 0.265, and p < 0.001. ACQ: Asthma Control Questionnaire; n: number of subjects; V: Cramer’s V.
Figure 4
Figure 4
(a) Correlation between fatigue and asthma-related quality of life (ρ = −0.554, p < 0.001) and (b) absence of correlation between fatigue and FEV1 (ρ = −0.083, p = 0.025). AQLQ: Asthma Quality of Life Questionnaire; CIS-Fatigue: Checklist Individual Strength-Fatigue; and FEV1: Forced Expiratory Volume in the first second.
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