Introduction Fatigue is a prominent disabling symptom in several chronic pulmonary diseases; however, its impact on HRQoL in patients with chronic pulmonary aspergillosis (CPA) has not been investigated.
Method Our 154 patients with CPA completed the Manchester COPD Fatigue Scale (MCFS), Thorax 2009)) and the SGRQ in our specialist referral centre. MCFS measures total fatigue and sub-components comprehensively. Lung function and body mass index were measured. Univariate and multivariate linear and binary analysis, and the principal component analysis (PCA) were used.
Results The mean (SD) age (61.1 (10.8)) years and 44% were female; FEV1% (63.3 (24.9)), BMI (23.7 (5.2)), SGRQ total score (55.6 (23.5) and MCFS total score (30 (14.9)).
PCA showed that 27 items of MCFS loaded clearly on three components: physical and psychosocial and cognitive fatigue.
Univariate analysis showed a strong association between total SGRQ score and MCFS score (r=0.81, p<0.001). Using total SGRQ as a dependent variable, linear multi-variate analysis showed that fatigue was the strongest factor (beta = 0.83 p<0.0001) associated with impaired health status followed by FEV1% (beta= –0.22, p=0.009), but no statistically significant association with age, BMI and pack/years. This model explained 70% of the variance of SGRQ total score.
Using patients’ self-assessment grades of SGRQ (Very poor, poor, fair, good and very good), one-way ANOVA showed that patients with “very poor” health status had the highest fatigue scores (45 (6.4)), following by poor (35 (10.1)), fair (30 (10.4)), good (14 (10.9)) and very good (0) (p<0.001). Splitting the group to (very poor and poor) versus (fair, good and very good), the ROC curve analysis indicated significant ability of MCFS and its components to detect change in HS (AUC=0.82; range 0.75–0.9, p<0.0001) as demonstrated in figure 1.
Furthermore, binary regression analysis showed that only fatigue score (OR=0.92, 95% CI 0.87–0.97; p=0.002) and FEV1% (OR=1.04, 95% CI 1.01–1.07, p=0.02) are significantly associated with impaired health status after correcting to age, gender and DLCO%.
Conclusion This is the first study directly implicating fatigue as a major factor affecting health-related-quality of life in patients with CPA.