Characterisation of fatigue and its substantial impact on health status in a large cohort of patients with chronic pulmonary aspergillosis (CPA). (May 2016)

• Record Type: Journal Article
• Authors: Al-shair, Khaled; Muldoon, Eavan G.; Morris, Julie; Atherton, Graham T.; Kosmidis, Chris; Denning, David W.
• Is Part Of: Respiratory medicine. Volume 114(2016)
• Page Start: 117
• Page End: 122
• Publication Date: 2016-05
• Subjects: Chronic pulmonary aspergillosis -- Aspergilloma -- Fatigue -- Health status; BMI Body Mass Index -- COPD Chronic obstructive pulmonary disease -- CPA Chronic pulmonary aspergillosis -- FEV1 Forced Expiratory Volume over 1 Second -- FVC Forced Vital Capacity -- IQR Interquartile range -- MCFS Manchester COPD fatigue scale -- MRC scale Medical Research Council Scale -- NAC National Aspergillosis Centre -- ROC Receiver Operating Characteristic -- SGRQ St Georges Respiratory Questionnaire; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2016.03.020
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Introduction: Fatigue is a prominent disabling symptom in several pulmonary diseases. Its impact on health status in patients with chronic pulmonary aspergillosis (CPA) has not been investigated. Methods: A total of 151 CPA patients attending the National Aspergillosis Centre completed Manchester COPD Fatigue Scale (MCFS), St. George's Respiratory Questionnaire (SGRQ) and Medical Research Council (MRC) dyspnoea score. Lung function and BMI were measured. Univariate, multivariate linear and binary analyses, and principal component analysis (PCA) were used. Results: Female patients accounted for 44%. The mean (range) of age was 59.6 (31–83) years, FEV1 % was 64 (14–140), BMI was 23.6 (16.3–43.4), SGRQ total score was 56 (4–96.2) and MCFS total score was 30.6 (0–54). PCA showed that 27 items of MCFS loaded on three components; physical, psychosocial and cognitive fatigue, explaining 78.4% of fatigue variance. MCFS score correlated strongly with total SGRQ score (r = 0.83, p < 0.001). Using linear multivariate analysis, fatigue was the strongest factor (beta = 0.7 p < 0.0001) associated with impaired health status, after adjusting for age, BMI, FEV1%, and MRC dyspnoea score. Using patients' 5 self-assessment grades of their health, one-way ANOVA showed that those with "very poor" health status had the highest fatigue scores (45 (±6) (p < 0.001)). Logistic regression analysis showed that fatigue score (OR = 0.9, 95% CI 0.84–0.97; p = 0.005) and FEV1 % (OR = 1.03, 95% CI 1.01–1.07, p = 0.02) are significantly associated with self-assessed impaired health status after correcting for age, gender and DLCO%. Conclusion: Fatigue is a major component of impaired health status of CPA patients. Highlights: Fatigue is a prominent disabling symptom in chronic pulmonary aspergillosis (CPA). Fatigue is a major component of impaired health status in CPA. Patients with more severe illness suffered considerably more fatigue.