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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is a disorder that affects the respiratory tract&#46; It is generally secondary to tobacco use and its course tends to be progressive and incapacitating&#44; with significant repercussions on quality of life and high mortality in patients&#46; Its manifestations include respiratory symptoms such as cough&#44; expectoration&#44; and dyspnea&#46; It also has extrapulmonary manifestations that significantly influence disease progress and prognosis&#46; Pain&#44; insomnia&#44; fatigue&#44; anorexia&#44; and weight loss are common symptoms&#46; Fatigue is the most common extrapulmonary symptom and the second most frequent symptom in general after dyspnea&#46;</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&#46; In a cross-sectional study&#44; 48&#46;5&#37; of patients with COPD had severe fatigue and 26&#37; had mild fatigue&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It was more frequent among patients who smoked and those who weighed less&#44; had greater dyspnea&#44; and had worse pulmonary function&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> In other studies&#44; dyspnea&#44; depression&#44; sleep quality&#44; and oxygen saturation were predictors of onset of fatigue&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Different scales have been used to evaluate fatigue in patients with COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Some are general multidimensional scales which&#44; in addition to the symptom&#44; evaluate some of its attributes such as duration&#44; frequency&#44; and rhythm&#46; Among them&#44; the Brief Fatigue Inventory&#44; Fatigue Assessment Scale&#44; Fatigue Severity Scale&#44; and Fatigue Impact Scale are of note&#46; Specific scales for the disease have also been developed&#44; such as the Manchester COPD Fatigue Scale and the COPD and Asthma Fatigue Scale&#46; The COPD Assessment Test &#40;CAT&#41; questionnaire is widely used in patients with COPD and includes an item on lack of energy&#44; an aspect related to the capacity for effort and fatigue&#46; The OLIN COPD study conducted in Sweden observed that a score &#8805;2 on the CAT question regarding energy can be a useful means for detecting fatigue in clinical practice&#46;<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&#46; In a study on more than 800 individuals&#44; Strandkvist et al&#46; observed that strength was diminished in patients with COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In addition&#44; hand grip strength in males&#44; but not in females&#44; was associated with fatigue regardless of age&#44; tobacco consumption&#44; or physical activity level&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this issue&#44; Alpaydin et al&#46; present a cross-sectional study examining fatigue in 64 males with COPD&#46;<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&#46; Dyspnea&#44; tobacco use&#44; and pulmonary function deterioration were associated with higher levels of fatigue&#46; 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&#46; However&#44; the study is on a small sample and its results must be evaluated with caution&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Fatigue is a symptom with significant repercussions on functional capacity&#44; health status&#44; and quality of life in patients with COPD&#46;<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&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> have more exacerbations&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> have more hospitalizations&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and have a higher mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Despite this&#44; patients often do not consult about this symptom and&#44; in many cases&#44; it goes unnoticed by healthcare professionals&#44; who tend to focus more on respiratory symptoms&#46; In addition&#44; fatigue has a more insidious course&#44; which means it goes unnoticed until the disease has been ongoing for a long period of time&#46;</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&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This makes treatment aimed at controlling it difficult&#46; Oxygen therapy<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and rehabilitation help improve the sensation of fatigue&#46; A recent meta-analysis examined the effect of different exercise-based interventions on fatigue in patients with COPD&#46; Both aerobic and anaerobic exercise or a combination of both were associated with an improvement in fatigue&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Different types of exercise can be done&#44; such as walking or running on a treadmill&#59; cycling&#59; weight lifting&#59; or using resistance machines for the quadriceps&#44; triceps&#44; or biceps&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We believe that for a proper approach to COPD&#44; other possible debilitating symptoms such as fatigue must be addressed in addition to dyspnea&#46; It is necessary to proactively detect their presence and&#44; as a rule&#44; recommend physical exercise to decrease their impact and improve patients&#8217; quality of life&#46;</p></span>"
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Editorial
Fatigue: A neglected symptom of COPD
La fatiga, un síntoma desatendido en la EPOC
M. Gericó Aseguinolaza, J. Díez-Manglano
Corresponding author
jdiez@aragon.es

Corresponding author.
Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
Related content
A.Ö. Alpaydin, R. Aktan, E. Keleş, S. Özalevli

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