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      Fatigue and multidimensional disease severity in chronic obstructive pulmonary disease

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          Abstract

          Background and aims

          Fatigue is associated with longitudinal ratings of health in patients with chronic obstructive pulmonary disease (COPD). Although the degree of airflow obstruction is often used to grade disease severity in patients with COPD, multidimensional grading systems have recently been developed. The aim of this study was to investigate the relationship between perceived and actual fatigue level and multidimensional disease severity in patients with COPD.

          Materials and methods

          Twenty-two patients with COPD (aged 52-74 years) took part in the study. Multidimensional disease severity was measured using the SAFE and BODE indices. Perceived fatigue was assessed using the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS). Peripheral muscle endurance was evaluated using the number of sit-ups, squats, and modified push-ups that each patient could do.

          Results

          Thirteen patients (59%) had severe fatigue, and their St George's Respiratory Questionnaire scores were significantly higher (p < 0.05). The SAFE index score was significantly correlated with the number of sit-ups, number of squats, FSS score and FIS score (p < 0.05). The BODE index was significantly associated with the numbers of sit-ups, squats and modified push-ups, and with the FSS and FIS scores (p < 0.05).

          Conclusions

          Peripheral muscle endurance and fatigue perception in patients with COPD was related to multidimensional disease severity measured with both the SAFE and BODE indices. Improvements in perceived and actual fatigue levels may positively affect multidimensional disease severity and health status in COPD patients. Further research is needed to investigate the effects of fatigue perception and exercise training on patients with different stages of multidimensional COPD severity.

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          The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients.

          Kadriye Armutlu, Nilufer Korkmaz, Zafer Guney … (2007)
          The aims of this study were to investigate the Fatigue Severity Scale's Turkish version's validity, reproducibility, internal consistency and parameters. Multiple sclerosis patients' disability levels were determined by the Expended Disability Status Scale and depression status was established with the Beck Depression Inventory. The Fatigue Severity Scale and Beck Depression Inventory were administered through self-report methods and assistance, without guidance, given where needed. An interval of 1 week was allowed between the applications. Seventy-two definitely diagnosed multiple sclerosis patients and matched 76 healthy controls were included. The multiple sclerosis patients' median Expended Disability Status Scale score was 4.0 (1.0-9.5). There were statistically significant differences between multiple sclerosis patients' and healthy controls' Fatigue Severity Scale scores (P<0.001). After controlling for depression, Fatigue Severity Scale scores were lowered, but there was still a significant difference between them (P<0.001). There was no significant difference between the interviews for Fatigue Severity Scale1 and Fatigue Severity Scale2 (P=0.719). Internal consistency for Fatigue Severity Scale was good for multiple sclerosis patients (ICC=0.81, P<0.001). Cronbach's alpha of Fatigue Severity Scale1 was 0.89; Fatigue Severity Scale2 was 0.94. Expended Disability Status Scale scores (P<0.05) and Beck Depression Inventory scores (P<0.001) have a significant effect on the Fatigue Severity Scale. In conclusion, scales have a great importance in following up and assessing the results of treatment strategies. The Turkish validation of the Fatigue Severity Scale is reliable and valid, and is an appropriate tool to assess fatigue in the Turkish multiple sclerosis population.
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            A multidimensional grading system (BODE index) as predictor of hospitalization for COPD.

            Arul Earnest, Jin-Jian Lu, Kian Ong (2005)
            We hypothesized that the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index would better predict hospitalization for COPD than FEV1 alone, and the purpose of this study was to test this hypothesis in a cohort of patients with COPD. Historical cohort study. University-affiliated hospital. One hundred twenty-seven patients with COPD recruited from the outpatient clinic of a single institution were followed up for a mean period of 16.2 months. The BODE index was calculated for each patient using variables obtained within 4 weeks of enrollment. The main outcome measure was the number of hospital admissions for COPD during follow-up. We used the Poisson regression model to quantify and compare the relationship between FEV1 and BODE scores with the number of hospital admissions. During the follow-up period, 47% of patients required at least one hospital admission and 17% died. Using Poisson regression analysis, a significant effect of BODE score on the number of hospital admissions was found (incidence rate ratio, 1.20; 95% confidence interval [CI], 1.15 to 1.25; p < 0.001). In comparison, there was a significant but smaller effect of the FEV1 percentage of predicted on the number of hospital admissions (incidence rate ratio, 0.08; 95% CI, 0.04 to 0.16; p < 0.001). When categorizing the BODE scores into four quartiles, we found that the BODE index is also a better predictor of hospital admissions than the staging system of COPD as defined by the Global Initiative for Chronic Obstructive Lung Disease. The pseudo r2 using quartiles of the BODE index as the predictor was 0.16, as compared to 0.04 for stages of severity based on FEV1. The BODE staging system, which includes in addition to FEV1 other physiologic and clinical variables, helps to better predict hospitalization for COPD.
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              Relevance of assessing quadriceps endurance in patients with COPD.

              C Coronell, Ingrid A Sarmiento, R. Mendez-Otero … (2004)
              The aims of this study were to investigate whether the impairment in endurance of limb muscles is a general finding in chronic obstructive pulmonary disease (COPD) patients, affecting even those with mild-to-moderate disease or relatively normal physical activity. In addition, this study aimed to determine the physiopathology of exhaustion in local endurance tests and whether the reduction in quadriceps endurance can be predicted from muscle strength measurements. A total of 75 volunteers were assigned to one of two groups according to pulmonary function tests: COPD patients or healthy age-matched controls. Functional assessment included both quadriceps strength (maximum voluntary contraction (QMVC)), and quadriceps endurance (contractions against a load equivalent to 10% QMVC until task failure or for up to a limiting time of 30 min (QTlim)). COPD patients showed a decrease of approximately 43%, in QMVC and approximately 77% in QTlim compared with controls. Task failure occurred only in COPD patients and was due to muscle fatigue, since limiting symptoms were associated with a decrease in the median frequency of quadriceps electromyographical signal and a reversible decrease in QMVC. The impairment in skeletal muscle endurance was present even in patients with mild-to-moderate airflow obstruction and individuals with relatively normal physical activity, and was irrespective of lung function variables, anthropometrical data or quadriceps strength. Peripheral muscle endurance was impaired in chronic obstructive pulmonary disease patients, even in those with relatively normal physical activity and mild-to-moderate airflow obstruction. This impairment associated with an early onset of muscle fatigue and could not be predicted from the severity of the disease or the reduction in quadriceps strength.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Multidiscip Respir Med
                Journal ID (iso-abbrev): Multidiscip Respir Med
                Title: Multidisciplinary Respiratory Medicine
                Publisher: BioMed Central
                ISSN (Print): 1828-695X
                ISSN (Electronic): 2049-6958
                Publication date Collection: 2010
                Publication date (Electronic): 30 June 2010
                Volume: 5
                Issue: 3
                Pages: 162-167
                Affiliations
                [1 ]Hacettepe University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey
                [2 ]Hacettepe University, Faculty of Medicine, Department of Chest Medicine, Ankara, Turkey
                Article
                Publisher ID: 2049-6958-5-3-162
                DOI: 10.1186/2049-6958-5-3-162
                PMC ID: 3463041
                PubMed ID: 22958301
                SO-VID: 341849c9-ce95-47bf-94c4-6ee8f60278fd
                Copyright © Copyright ©2011 Novamedia srl
                History
                Date received : 15 December 2009
                Date accepted : 10 February 2010
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Respiratory medicine
                Keywords: bode index,disease severity,copd,safe index,fatigue,endurance
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: bode index, disease severity, copd, safe index, fatigue, endurance

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