Chest
Volume 114, Issue 4, October 1998, Pages 958-964
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Clinical Investigations: COPD
Perception of Fatigue and Quality of Life in Patients With COPD

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Introduction

Although dyspnea is considered the primary activity-limiting symptom in patients with COPD, other symptoms, such as fatigue, are frequently reported. The purpose of this study was to determine the relationship between fatigue and pulmonary function, exercise tolerance, depression, and quality of life in patients with COPD.

Methods

Forty-one patients (age = 62 ± 8 years; FEV1 = 1.08 ± 0.55 L; FEV1 percent predicted = 35.8 ± 17%) from two sites participated in the study. Spirometric measures of pulmonary function were carried out in each patient. The Multidimensional Fatigue Inventory was used to measure five subscales of fatigue: general, physical and mental fatigue, reduction in activity, and reduction in motivation. The St. George Respiratory Questionnaire, used to measure quality of life, has three subscale dimensions (symptom, activity, and impact), as well as an overall or total quality of life score. Depression was measured with the Centers of Epidemiological Studies Depression Scale. In 19 patients, exercise tolerance was determined with the 6-min walking distance.

Results

General fatigue correlated with FEVl, percent predicted (r = −0.32, p < 0.05), exercise tolerance (r = −0.55, p < 0.05), depression (r = 0.44, p < 0.01), and overall quality of life (r = 0.75, p < 0.01). Among the dimensions of fatigue, depression correlated with general and mental fatigue only. Physical dimensions of fatigue correlated with an increase in the severity of pulmonary impairment and reduction in exercise tolerance. The cognitive components of fatigue, such as reduction in motivation and mental fatigue, were not found to be highly correlated with physical dimensions of quality of life. All five subscales of fatigue showed relationship to the functional impact dimension and total impairment score in quality of life.

Conclusions

These data show a relationship between dimensions of fatigue and pulmonary function, exercise tolerance, and quality of life in COPD. Based on these results, fatigue is an important symptom requiring evaluation and management in patients with COPD. These data clarified also the relationship between depression and fatigue in this patient population.

Section snippets

Sample

A convenience sample of 41 patients with stable COPD (FEV1 = 1.08 L [±0.55], FEV1, percent predicted = 35.8% [±16.6]) from two sites participated in the study. Based on Cohen's standard approach for correlation,22 anticipating a moderate effect size, the sample size is adequate to achieve the purpose of evaluating universal similarities of fatigue in this population from two international sites. The study was approved by the Human Subjects Review Board at the University of California, Davis and

RESULTS

Forty-one patients (28 male, 13 female) with moderate to severe COPD participated in the study (Table 1). There were no significant differences between the Dutch and American groups in each dimension of fatigue (Table 2). American patients showed a trend toward lower FVC, percent predicted (p = 0.055) than the Dutch patients but not with any other pulmonary function values. The American patients showed higher scores, and therefore, greater impairment in the activity subscale of the SGRQ (p <

DISCUSSION

Among the possible dimensions of fatigue in COPD, we measured five in the present study in the MFI-20: general or overall fatigue, two physical dimensions, physical fatigue and reduction in activity, and two cognitive dimensions, reduction in motivation and mental fatigue. Data from the present study were considered as regards the expected relationships between fatigue and the outcome measures. We show three major findings. Increased fatigue is associated with (1) an increase in the severity of

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