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. 2025 Oct 13;11(5):00857-2024.
doi: 10.1183/23120541.00857-2024. eCollection 2025 Sep.

Associated factors of fatigue in patients with COPD: results from the FAntasTIGUE study

Maarten Van Herck  1   2   3   4 , Yvonne M J Goërtz  5 , Zjala Ebadi  6   7 , Chris Burtin  3 , Jeannette B Peters  7 , Melissa S Y Thong  8 , Rein Posthuma  1   2   4 , Jean W M Muris  9 , Erik W M A Bischoff  10 , Emiel F M Wouters  2   11 , Mirjam A G Sprangers  8   12 , Jan H Vercoulen  6   7 , Daisy J A Janssen  1   5   9 , Martijn A Spruit  1   2
Affiliations

Associated factors of fatigue in patients with COPD: results from the FAntasTIGUE study

Maarten Van Herck et al. ERJ Open Res. .

Abstract

Background: Fatigue is present in about half of the patients with COPD. The associated factors of fatigue in COPD remain unclear and have not been studied in an integrated and holistic analysis. The aim of this study is to identify associated factors of fatigue in COPD.

Methods: In this cross-sectional study, clinically stable patients with COPD from primary and secondary care were assessed for fatigue (Checklist Individual Strength Subjective Fatigue (CIS-Fatigue)), other symptoms, medication, and personal, COPD-related, physical, psychological and systemic factors. Multivariable stepwise regression analyses were performed for each domain, followed by a multivariable (enter) model with all identified factors.

Results: In total, 247 patients with COPD (67±8 years, 60% male, forced expiratory volume in 1 s 57±21% predicted, 27% Global Initiative for Chronic Obstructive Lung Disease (GOLD) E) were included in the study of which 51% reported severe fatigue (CIS-Fatigue ≥36 points). Distinct models for each group of factors identified the following factors associated with a higher level of fatigue: living alone, antidepressant use, anxiolytic use, systemic antihistamines use, higher Charlson comorbidity score, lower diffusion capacity, higher number of moderate exacerbations in the last year, higher dyspnoea, reduced sleep quality, higher pain, lower functional exercise capacity, higher fatigue-related catastrophising, more depressive symptoms, lower calcium and higher leukocyte count. The final model explained 46.6% of variance in fatigue with dyspnoea, sleep quality, fatigue-catastrophising and pain as significant associated factors (F(17, 184)=11.312, p<0.001).

Conclusion: Pain, sleep quality, dyspnoea and fatigue-catastrophising were identified as associated factors of fatigue. These factors should not be overlooked when treating fatigue in patients with COPD.

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Conflict of interest statement

Conflict of interest: M. Van Herck, Y.M.J. Goërtz, Z. Ebadi, C. Burtin, J.B. Peters, M.S.Y. Thong, R. Posthuma, J.W.M. Muris, E.W.M.A. Bischoff, E.F.M. Wouters, M.A.G. Sprangers and J.H. Vercoulen have nothing to disclose. D.J.A. Janssen reports grants from the Stichting Astmabestrijding and the Netherlands Respiratory Society, and speaker fees from Chiesi, Abbott and AstraZeneca in the past 36 months outside the submitted work and all paid to her institution. M.A. Spruit reports grants from Lung Foundation Netherlands, Stichting Astma Bestrijding, Boehringer Ingelheim and AstraZeneca to support the FAntasTIGUE project, grants from Boehringer Ingelheim, AstraZeneca, TEVA, Chiesi and Sanofi outside the submitted work, consulting fees from Boehringer Ingelheim and GSK, and speaker fees from Boehringer Ingelheim in the past 36 months outside the submitted work. All payments were made to his institution.

Figures

FIGURE 1
FIGURE 1
Flowchart of study population. FEV1/FVC: forced expiratory volume in 1 s to forced vital capacity ratio.
FIGURE 2
FIGURE 2
Visual presentation of all potential factors of fatigue considered per domain and identified associated factors of fatigue in COPD per model (in pale blue circle). Pain, dyspnoea, sleep quality and fatigue-related catastrophising (in red) were found to be significant associated factors of fatigue in COPD in the final model that included all identified factors per domain. BMI: body mass index; HsCRP: high sensitivity C-reactive protein; TSH: thyroid-stimulating hormone; ANA: antinuclear antibody test; NT-proBNP: N-terminal pro-brain natriuretic peptide; ASAT: aspartate amino transferase; ALAT: alanine amino transferase; Hb: haemoglobin; vit. D3: vitamin 25-hydroxyvitamin D3; vit. B12: vitamin B12.
See this image and copyright information in PMC

References

    1. Machado A, Marques A, Burtin C. Extra-pulmonary manifestations of COPD and the role of pulmonary rehabilitation: a symptom-centered approach. Expert Rev Respir Med 2021; 15: 131–142. doi: 10.1080/17476348.2021.1854737 - DOI - PubMed
    1. Ream E, Richardson A. Fatigue: a concept analysis. Int J Nurs Stud 1996; 33: 519–529. doi: 10.1016/0020-7489(96)00004-1 - DOI - PubMed
    1. Ebadi Z, Goërtz YMJ, Van Herck M, et al. The prevalence and related factors of fatigue in patients with COPD: a systematic review. Eur Respir Rev 2021; 30: 200298. doi: 10.1183/16000617.0298-2020 - DOI - PMC - PubMed
    1. Blinderman CD, Homel P, Billings JA, et al. Symptom distress and quality of life in patients with advanced chronic obstructive pulmonary disease. J Pain Symptom Manage 2009; 38: 115–123. doi: 10.1016/j.jpainsymman.2008.07.006 - DOI - PubMed
    1. Kapella MC, Larson JL, Patel MK, et al. Subjective fatigue, influencing variables, and consequences in chronic obstructive pulmonary disease. Nurs Res 2006; 55: 10–17. doi: 10.1097/00006199-200601000-00002 - DOI - PubMed

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