From the Guidelines
COPD causes fatigue primarily due to a combination of factors including decreased oxygen levels, increased energy expenditure during breathing, and systemic inflammation, which collectively lead to muscle weakness and reduced oxygen transport capacity. When airways become narrowed and damaged in COPD, less oxygen enters the bloodstream while the body must work harder to breathe, requiring more energy than normal breathing 1. This oxygen deficit means muscles and organs receive less oxygen for energy production, while the respiratory muscles themselves become overworked and inefficient. Additionally, COPD often disrupts sleep patterns due to nighttime symptoms and breathing difficulties, leading to poor sleep quality and daytime fatigue.
Some key factors contributing to fatigue in COPD patients include:
- Decreased oxygen levels in the blood
- Increased energy expenditure during breathing
- Systemic inflammation associated with COPD
- Muscle weakness and wasting due to malnutrition and increased resting metabolic rate 1
- Anemia, which further reduces oxygen transport capacity
- Depression and anxiety, common in COPD patients, which can worsen feelings of fatigue
Management of fatigue in COPD typically includes:
- Bronchodilators like albuterol or tiotropium to ease breathing
- Pulmonary rehabilitation to improve exercise capacity 1
- Oxygen therapy when indicated
- Addressing sleep issues and psychological factors
- Pacing daily activities and energy conservation techniques to manage fatigue in COPD patients.
From the Research
Factors Contributing to Fatigue in COPD
- Dyspnea, pain, anxiety, depression, and sleep are related to fatigue in COPD, as identified in a scoping review of 25 articles 2
- Patients with COPD perceive severe negative impact of fatigue on their daily lives, limiting physical, emotional, cognitive, and social functioning 3
- Fatigue is a debilitating symptom with factors influential to the symptom and outcomes, requiring targeted and personalized interventions to mitigate its effects 2
Prevalence of Fatigue in COPD
- Fatigue is highly prevalent in patients with COPD, with a higher mean fatigue score and a higher proportion of severe fatigue compared to subjects without COPD 4
- Severe fatigue is prevalent in half of the patients with COPD, and correlates poorly with the degree of airflow limitation 4
Impact of Fatigue on Daily Life
- Fatigue causes a high mental burden, challenging patients' coping resources and making it a symptom difficult to accept 3
- Patients with COPD report that fatigue limits their daily activities and causes them to lose the joy in life or even the will to live 3
- A multidisciplinary approach and blended care, including online treatment and face-to-face contact with a healthcare professional, may be effective in managing fatigue 3