What is the treatment approach for a patient presenting with asthenia?

Treatment Approach for Asthenia

The treatment of asthenia requires identifying and addressing the underlying cause, as asthenia is a symptom rather than a disease itself. 1

Understanding Asthenia

• Asthenia refers to a subjective feeling of weakness or lack of energy, not necessarily related to physical effort 2
• It affects approximately 30% of patients in ambulatory settings, with chronic fatigue representing up to 10% of these cases 1
• Asthenia should be differentiated from weakness, dizziness, or dyspnea, as patients may confuse these symptoms 1

Diagnostic Approach

• Classify asthenia based on duration:

  • Prolonged fatigue: lasting more than one month
  • Chronic fatigue: persisting beyond six months 1

• Identify potential underlying causes:

  • Psychological: Depression (accounts for approximately 50% of cases) 1
  • Medical conditions: Cardiovascular diseases, cerebrovascular pathology 3
  • Age-related: Senile asthenia syndrome in older adults 3
  • Post-infectious: Including post-COVID asthenia 3
  • Cancer-related: Most frequent and disabling symptom in cancer patients 4

Treatment Algorithm

1. Address underlying causes:

   • The most effective treatment is resolving the primary condition 1
   • Note that up to 20% of patients may remain without a definitive diagnosis 1

2. Pharmacological interventions:

   • For asthenia associated with cerebrovascular pathology: Consider citicoline (500 mg/day for 30 days) which has demonstrated antiasthenic effects 3
   • For functional asthenia: Sulbutiamine, a lipophilic thiamine derivative, may be beneficial as it crosses the blood-brain barrier and acts on brain structures involved in asthenia 5

3. For cancer-related asthenia:

   • Implement a multidisciplinary approach targeting contributing factors such as:
     • Anemia
     • Anxiety and depression
     • Sleep disorders
     • Pain
     • Malnutrition 4

4. Supportive measures:

   • Ensure adequate rest periods
   • Address sleep disturbances
   • Manage mood instability and irritability 3

Special Considerations

• In elderly patients with senile asthenia syndrome, treatment should focus on addressing age-associated decreases in physiological reserves and functions, including cognitive functions 3
• For post-COVID asthenia, targeted interventions addressing both physical and cognitive fatigue may be necessary 3

Follow-up

• Regular assessment of symptom improvement
• Continued evaluation for underlying causes if symptoms persist
• Adjustment of treatment plan based on response 1