Abstract
Purpose
To evaluate perceived fatigue (PF) and neuromuscular fatigue (NMF) in patients with COPD and chronic respiratory failure (CRF) on long-term oxygen therapy (CRF-COPD group), and the relationships between PF, NMF, patient’s characteristics, comparing severe patients with COPD to patients without CRF (COPD group).
Methods
This cross-sectional study compared 19 CRF-COPD patients with 10 COPD patients attending a rehabilitation program. PF was determined by Fatigue Severity Scale (FSS), while dyspnea by the Barthel Dyspnea Index (BDI). We assessed quadriceps NMF via electrical nerve stimulation during and following a Maximal Voluntary Contraction (MVC) detecting changes after a Constant Workload Cycling Test (CWCT) at 80% of the peak power output at exhaustion.
Results
CRF-COPD patients showed higher PF (+ 1.79 of FSS score, p = 0.0052) and dyspnea (+ 21.03 of BDI score, p = 0.0023) than COPD patients. After the fatiguing task and normalization for the total work, there was a similar decrease in the MVC (CRF-COPD −1.5 ± 2.4 vs COPD −1.1 ± 1.2% baseline kJ−1, p = 0.5819), in the potentiated resting twitch force (CRF-COPD −2.8 ± 4.7 vs COPD −2.0 ± 3.3% baseline kJ−1, p = 0.7481) and in the maximal voluntary activation (CRF-COPD −0.1 ± 3.9 vs COPD −0.9 ± 1.2 −2.0 ± 3.3% baseline kJ−1, p = 0.4354). FSS and BDI were closely related (R = 0.5735, p = 0.0011), while no correlation between PF and NMF was found.
Conclusion
Patients with CRF-COPD develop higher levels of perceived fatigue and dyspnea than patients with COPD; while neuromuscular fatigue is similar, suggesting a mismatch between symptoms and neuromuscular dysfunction.
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Abbreviations
- 6MWT:
-
6 Minute Walk Test
- ABG:
-
Arterial Blood Gas
- ADL:
-
Activity of Daily Living
- BDI:
-
Barthel Dyspnea Index
- BMI:
-
Body Mass Index
- CIRS:
-
Cumulative Illness Rating Scale
- COPD:
-
Chronic obstructive pulmonary disease
- CRF:
-
Chronic respiratory failure
- CWCT:
-
Constant Workload Cycling Test
- FEV1 :
-
Forced Expiratory Volume in the 1st second
- FiO2 :
-
Inspiratory Fraction of Oxygen
- FSS:
-
Fatigue Severity Scale
- FVC:
-
Forced Volume Capacity
- GOLD:
-
Global Initiative for Chronic Obstructive Lung Disease
- HR:
-
Heart Rate
- LTOT:
-
Long-term oxygen therapy
- MAP:
-
Mean Arterial Pressure
- MVA:
-
Voluntary Muscle Activation
- MVC:
-
Maximal Voluntary Contraction
- NMF:
-
NeuroMuscular fatigue
- O2 :
-
Oxygen
- PaCO2 :
-
Arterial Carbon Dioxide Partial Pressure
- PaO2 :
-
Arterial Oxygen Partial Pressure
- PF:
-
Perceived fatigue
- PPO:
-
Peak Power Output
- Qtwpot:
-
Potentiated quadriceps twitch force
- RPE:
-
Rate of Perceived Exertion
- RV:
-
Residual Volume
- SPO2 :
-
Arterial Oxygen Saturation
- Tlim:
-
Time to exhaustion of exercise
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Acknowledgements
The Authors thank all Respiratory Rehabilitation physiotherapists of the Institute of Lumezzane (BS) of Istituti Clinici Scientifici Maugeri IRCCS, who treated the patients enrolled in this study, Rosemary Allpress for English revision, and Adriana Olivares for technical assistance and editing.
Funding
This work is a sub-analysis of data from two studies conducted in our Institute: CE 2288, funded by 5 × 1000 grant of the Italian Ministry of Health, related to training in COPD and CRF patients; and CE 2241, supported by “Ricerca Corrente” funding of the Ministry of Health, related to strength training in non-hypoxemic COPD patients.
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The contributions of the author were as follows: conceptualization and methodology, MP, MV; validation, MP; formal analysis, MP; investigation, MS, BS; data curation, BS, MS; writing—original draft preparation, MP, MV, MV; writing-review and editing, MP, MV, MV, LC, BS, MS, FS; supervision, MV, FS; project administration, MP, MV.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the ICS Maugeri (Pavia, CE 2288 and 2241).
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The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Communicated by Susan Hopkins .
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Paneroni, M., Vitacca, M., Comini, L. et al. Relationship between perceived and neuromuscular fatigue in COPD patients with chronic respiratory failure with long-term oxygen therapy: a cross-sectional study. Eur J Appl Physiol 122, 2403–2416 (2022). https://doi.org/10.1007/s00421-022-05021-2
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DOI: https://doi.org/10.1007/s00421-022-05021-2