Fatigue in patients with COPD participating in a pulmonary rehabilitation program

Cindy J Wong1, Donna Goodridge1, Darcy D Marciniuk2, Donna Rennie1,31College of Nursing, 2College of Medicine, 3Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, CanadaBackground: Fatigue is a distressing, complex, multidimensional sensation common in individuals with chronic obstructive pulmonary disease (COPD). While fatigue negatively impacts functional performance and quality of life, there has been little study of the fatigue that affects participants in pulmonary rehabilitation programs. The purpose of this study was to examine the emotional, behavioral, cognitive, and physical dimensions of fatigue and their relationships to dyspnea, mental health, sleep, and physiologic factors.Patients and methods: A convenience sample of 42 pulmonary rehabilitation participants with COPD completed self-report questionnaires which measured dimensions of fatigue using the Multidimensional Fatigue Inventory, anxiety and depression using the Hospital Anxiety and Depression Scale, and sleep quality using the Pittsburgh Sleep Quality Index. Data on other clinical variables were abstracted from pulmonary rehabilitation program health records.Results: Almost all (95.3%) participants experienced high levels of physical fatigue. High levels of fatigue were also reported for the dimensions of reduced activity (88.1%), reduced motivation (83.3%), mental fatigue (69.9%), and general fatigue (54.5%). Close to half (42.9%) of participants reported symptoms of anxiety, while almost one quarter (21.4%) reported depressive symptoms. Age was related to the fatigue dimensions of reduced activity (ρ = 0.43, P < 0.01) and reduced motivation (ρ = 0.31, P < 0.05). Anxiety was related to reduced motivation (ρ = -0.47, P < 0.01). Fatigue was not associated with symptoms of depression, sleep quality, gender, supplemental oxygen use, smoking status, or Medical Research Council dyspnea scores.Conclusions: Fatigue (particularly the physical and reduced motivation dimensions of fatigue) was experienced by almost all participants with COPD attending this pulmonary rehabilitation program. Fatigue affected greater proportions of participants than either anxiety or depression. The high prevalence of fatigue may impact on enrolment, participation, and attrition in pulmonary rehabilitation programs. Further investigation of the nature, correlates, and impact of fatigue in this population is required.Keywords: COPD, fatigue, pulmonary rehabilitation, anxiety, depression, sleep qualit

Test-Retest Reliability and Physiological Responses Associated with the Steep Ramp Anaerobic Test in Patients with COPD

The Steep Ramp Anaerobic Test (SRAT) was developed as a clinical test of anaerobic leg muscle function for use in determining anaerobic power and in prescribing high-intensity interval exercise in patients with chronic heart failure and Chronic Obstructive Pulmonary Disease (COPD); however, neither the test-retest reliability nor the physiological qualities of this test have been reported. We therefore, assessed test-retest reliability of the SRAT and the physiological characteristics associated with the test in patients with COPD. 11 COPD patients (mean FEV1 43% predicted) performed a cardiopulmonary exercise test (CPET) on Day 1, and an SRAT and a 30-second Wingate anaerobic test (WAT) on each of Days 2 and 3. The SRAT showed a high degree of test-retest reliability (ICC = 0.99; CV = 3.8%, and bias 4.5 W, error −15.3–24.4 W). Power output on the SRAT was 157 W compared to 66 W on the CPET and 231 W on the WAT. Despite the differences in workload, patients exhibited similar metabolic and ventilatory responses between the three tests. Measures of ventilatory constraint correlated more strongly with the CPET than the WAT; however, physiological variables correlated more strongly with the WAT. The SRAT is a highly reliable test that better reflects physiological performance on a WAT power test despite a similar level of ventilatory constraint compared to CPET

Role of Leukotriene Receptor Antagonists in the Treatment of Exercise-Induced Bronchoconstriction: A Review

Asthma is a very common disorder that still causes significant morbidity and mortality. A high percentage of individuals with asthma also experience exercise-induced bronchoconstriction (EIB). This article reviews the current literature and updates the reader on the safety, efficacy, and clinical applications of leukotriene modifiers in the treatment of EIB

Three-month recovery from common negative physical, functional, and psychosocial effects among individuals infected with COVID-19: a single observational group repeated measure study

Purpose: We examined three-month recovery from common negative effects of COVID-19 infection on select physical, functional, and psychosocial parameters among infected individuals and their implications for rehabilitation programs. Methods: Twenty-one subjects participated in this study. Four standardized questionnaires were used to assess dyspnea, physical, and psychosocial variables in this study. The post-test survey was conducted 90 days following the pre-test survey. Wilcoxon-Signed Rank test and paired t-test were used to compare the variables data between pre- and post-testing time points. Results: Dyspnea scores decreased from (pre: 2 vs post:1, Z=-3.276, p=0.001, r=.50). Work performance scores increased from (pre: 42 ±25 vs post: 57 ±21, t(20) =-2.868, p=0.010, r=.62). Social functioning increased from (pre: 44 ±27 vs post: 60 ±24, t(20) =-3.525, p=0.002, r=.76) and pain scores from (pre: 42 ±30 vs post: 53 ±25, t(20) =-2.134, p=0.045, r=.46) also increased across the 90 days. Conclusions: Long-term symptoms after COVID-19 infection include ongoing physical, functional, and psychosocial deficits. While dyspnea decreased and work performance and social functioning increased, we observed a concomitant increase in pain scores over the 90-day measurement period. Long-term multidisciplinary rehabilitation programs should be designed to address the ongoing deficits among this population

Psychological distress is related to poor health behaviours in COPD and non-COPD patients: Evidence from the CanCOLD study

Background Patients with psychiatric disorders (depression, anxiety) are more likely to have poor health behaviours, including higher smoking and lower physical activity (PA) levels. Smoking is a major risk factor for Chronic Obstructive Pulmonary Disease (COPD), and PA is critical for COPD management. However, no studies have assessed associations between psychological distress and these behaviours among patients with vs without COPD. This is a sub-analysis of the CanCOLD study that assessed the relationships between psychological disorders (depression, anxiety) and poor health behaviours (smoking, PA). Methods 717 COPD and 797 matched non-COPD individuals from the CanCOLD study, completed the Hospital Anxiety Depression Scale (HADS) to assess anxiety and depression. Smoking behaviour was self-reported pack-years smoking. The CHAMPS PA questionnaire determined calorific expenditure as a PA measure. Regressions determined relationships between anxiety/depression and health behaviours, adjusting for age, sex, BMI, GOLD stage and COPD status. Results Across the whole sample, we observed relationships between depression (β = 1.107 ± 0.197; 95%CI = 0.691–1.462; p < .001) and anxiety (β = 0.780 ± 0.170; 95%CI = 0.446–1.114; p < .001) and pack years. Higher depression (β = −0.220 ± 0.028; 95%CI = −0.275 to −0.165; p < .001) and anxiety (β = −0.091 ± 0.025; 95%CI = −0.139 to −0.043; p < .001) scores were related to lower PA. These associations were comparable across COPD and non-COPD patients. Conclusions Results showed that higher levels of anxiety and depression were related to higher cumulative smoking and lower levels of PA in patients with and without COPD, suggesting symptoms of psychological distress is similarly associated with poorer health behaviours in COPD and non-COPD individuals. Future studies need to determine if treating symptoms of psychological distress can improve health behaviours and outcomes in this population