Karin B Fieten, Lianne Ten Have, Linde N Nijhof, Lucia Rijssenbeek-Nouwens, Anneke Ten Brinke
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引用次数: 0
Abstract
Background: Fatigue is a major concern for patients with severe asthma.
Objective: This observational study aims to assess fatigue severity and associated factors, to explore the effect of pulmonary rehabilitation on fatigue, and to investigate which factors predict persistent severe fatigue.
Methods: Patients with severe, uncontrolled asthma referred for alpine altitude climate treatment (AACT) between 2007 and 2018 were systematically assessed pre- and post-rehabilitation regarding clinical, inflammatory, functional, and psychological characteristics. Fatigue severity was assessed by Checklist Individual Strength (CIS-Fatigue). Multivariable regression analyses were used to identify factors associated with fatigue severity and persistence.
Results: 420 patients were assessed of whom 91% reported severe fatigue (CIS-Fatigue ≥36). Stepwise multiple regression explained 35% of variance in initial fatigue severity. Significant contributing factors were higher ACQ (36%), sleeping problems (21%), female sex (19%), reflux (12%) and lower FENO (12%). AACT led to significant improvements in CIS-Fatigue (median(IQR) 50(11) to 27(21)) (p<0.001), ACQ (3.0(1.3) to 1.2(1.3)) (p<0.001), and other asthma outcomes. However, 27% of patients reported persistent severe fatigue, correlating with less improvement in asthma outcomes. Daily oral corticosteroid (OCS) use OR(95%CI) 2.4(1.4-4.1), sleeping problems OR(95%CI) 2.7(1.6-4.5), initial very severe fatigue OR(95%CI) 3.1(1.6-6.3), and older age OR(95%CI) 1.02 (1.0-1.04) were independent predictors of persistent severe fatigue.
Conclusion: Severe fatigue is highly prevalent in patients with severe, uncontrolled asthma. Alpine altitude climate treatment results in recovered fatigue and improved asthma control in most patients. Predicting factors of persistent fatigue suggest exploring the effect of targeted treatment strategies beyond the asthma domain.
期刊介绍：
JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases.
This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders.
The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.
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