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The following is a summary of “Severe Fatigue in Uncontrolled Asthma: Contributing Factors and Impact of Rehabilitation,” published in the September 2024 issue of Allergy and Immunology by Fieten et al.

Fatigue is a significant and often debilitating concern for patients who have severe asthma, impacting their overall quality of life. This observational study sought to evaluate the severity of fatigue in individuals with severe, uncontrolled asthma, identify associated clinical and psychological factors, assess the impact of pulmonary rehabilitation through Alpine Altitude Climate Treatment (AACT) on fatigue, and determine the predictors of persistent severe fatigue despite treatment. A cohort of 420 patients referred for AACT between 2007 and 2018 was systematically assessed before and after rehabilitation. 

These assessments encompassed a range of clinical, inflammatory, functional, and psychological characteristics, with fatigue severity measured using the Checklist Individual Strength (CIS-Fatigue) scale. The study found that 91% of patients reported severe fatigue, defined by a CIS-Fatigue score of 36 or higher. Stepwise multiple regression analysis identified several key factors contributing to initial fatigue severity, accounting for 35% of the variance. These included higher Asthma Control Questionnaire (ACQ) scores (36%), sleeping problems (21%), female sex (19%), gastroesophageal reflux (12%), and lower fractional exhaled nitric oxide (FeNO) levels (12%). AACT led to significant improvements in fatigue severity, with median CIS-Fatigue scores dropping from 50 to 27 (p<0.001), alongside notable enhancements in ACQ scores and other asthma-related outcomes. 

Despite these improvements, 27% of patients continued to experience persistent severe fatigue post-treatment, closely associated with less marked improvements in overall asthma control. Further analysis revealed that daily oral corticosteroid use, the presence of sleeping problems, initial very severe fatigue, and older age were independent predictors of persistent severe fatigue. These findings underscore the high prevalence of severe fatigue in patients with severe asthma and highlight the effectiveness of AACT in alleviating fatigue and improving asthma control for most patients. However, the persistence of severe fatigue in a subset of patients suggests a need for targeted treatment strategies that address factors beyond asthma management, such as sleep disorders and psychological support, to enhance patient outcomes further.

Source: sciencedirect.com/science/article/pii/S2213219824008833