Editorial
Fatigue: A neglected symptom of COPD
La fatiga, un síntoma desatendido en la EPOC
Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
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Gericó Aseguinolaza, J. Díez-Manglano" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Gericó Aseguinolaza" ] 1 => array:4 [ "nombre" => "J." "apellidos" => "Díez-Manglano" "email" => array:1 [ 0 => "jdiez@aragon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La fatiga, un síntoma desatendido en la EPOC" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease (COPD) is a disorder that affects the respiratory tract. It is generally secondary to tobacco use and its course tends to be progressive and incapacitating, with significant repercussions on quality of life and high mortality in patients. Its manifestations include respiratory symptoms such as cough, expectoration, and dyspnea. It also has extrapulmonary manifestations that significantly influence disease progress and prognosis. Pain, insomnia, fatigue, anorexia, and weight loss are common symptoms. Fatigue is the most common extrapulmonary symptom and the second most frequent symptom in general after dyspnea.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of fatigue in patients with COPD is much higher than what is observed in the general population. In a cross-sectional study, 48.5% of patients with COPD had severe fatigue and 26% had mild fatigue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It was more frequent among patients who smoked and those who weighed less, had greater dyspnea, and had worse pulmonary function.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> In other studies, dyspnea, depression, sleep quality, and oxygen saturation were predictors of onset of fatigue.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Different scales have been used to evaluate fatigue in patients with COPD.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Some are general multidimensional scales which, in addition to the symptom, evaluate some of its attributes such as duration, frequency, and rhythm. Among them, the Brief Fatigue Inventory, Fatigue Assessment Scale, Fatigue Severity Scale, and Fatigue Impact Scale are of note. Specific scales for the disease have also been developed, such as the Manchester COPD Fatigue Scale and the COPD and Asthma Fatigue Scale. The COPD Assessment Test (CAT) questionnaire is widely used in patients with COPD and includes an item on lack of energy, an aspect related to the capacity for effort and fatigue. The OLIN COPD study conducted in Sweden observed that a score ≥2 on the CAT question regarding energy can be a useful means for detecting fatigue in clinical practice.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Another simple test is hand grip strength measured using a dynamometer. In a study on more than 800 individuals, Strandkvist et al. observed that strength was diminished in patients with COPD.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In addition, hand grip strength in males, but not in females, was associated with fatigue regardless of age, tobacco consumption, or physical activity level.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this issue, Alpaydin et al. present a cross-sectional study examining fatigue in 64 males with COPD.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The authors measured fatigue using the Fatigue Severity Scale and quality of life with the SF-36 questionnaire. Dyspnea, tobacco use, and pulmonary function deterioration were associated with higher levels of fatigue. One of the most interesting results of the study is the association of fatigue both with the physical component and the mental component on this last scale. However, the study is on a small sample and its results must be evaluated with caution.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Fatigue is a symptom with significant repercussions on functional capacity, health status, and quality of life in patients with COPD.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It has been observed that patients who experience fatigue have a lower capacity for exercise and walk less on the six-minute walk test,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> have more exacerbations,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> have more hospitalizations,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and have a higher mortality rate.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Despite this, patients often do not consult about this symptom and, in many cases, it goes unnoticed by healthcare professionals, who tend to focus more on respiratory symptoms. In addition, fatigue has a more insidious course, which means it goes unnoticed until the disease has been ongoing for a long period of time.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The physiopathology of fatigue in COPD is complex and multifactorial in origin and its mechanisms are not known in great detail.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This makes treatment aimed at controlling it difficult. Oxygen therapy<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and rehabilitation help improve the sensation of fatigue. A recent meta-analysis examined the effect of different exercise-based interventions on fatigue in patients with COPD. Both aerobic and anaerobic exercise or a combination of both were associated with an improvement in fatigue.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Different types of exercise can be done, such as walking or running on a treadmill; cycling; weight lifting; or using resistance machines for the quadriceps, triceps, or biceps.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We believe that for a proper approach to COPD, other possible debilitating symptoms such as fatigue must be addressed in addition to dyspnea. It is necessary to proactively detect their presence and, as a rule, recommend physical exercise to decrease their impact and improve patients’ quality of life.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gericó Aseguinolaza M, Díez-Manglano J. 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| Year/Month | Html | Total | |
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