Medications Affect Fatigue Severity in Pulmonary Hypertension Patients, Study Shows
For pulmonary hypertension patients, medications they are taking can influence the severity of their fatigue, a common but often unaddressed symptom of the disease, a study suggests.
Findings were published in the study, “Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors,” in the journal European Respiratory Society Open Research.
Pulmonary hypertension (PH) is a lung disease caused by increased blood pressure in pulmonary arteries resulting in breathing difficulty. Fatigue or tiredness is one of the most common symptoms of PH, reported by up to 57 percent of patients. Although chronic fatigue negatively impacts the patient’s quality of life, this symptom has not been sufficiently addressed in research or in practice.
In this study, researchers examined the prevalence of fatigue in PH patients, and analyzed how health status and PH therapies affect this symptom.
Data was collected in 2014 from patients who attended the PHA 11th International Pulmonary Hypertension Conference and Scientific Sessions conference in Indianapolis. A total of 120 attendees, between the ages of 21 and 79, participated in the study. Information on their height, weight, and medication use was collected.
Fatigue was scored using the Multidimensional Fatigue Inventory-20 (MFI-20), a patient-reported questionnaire that assesses fatigue on five subscales: general, mental, physical, reduced activity, and reduced motivation. Each participant rated each area of the scale using a point system that correlated with symptom severity ranging from mild to very severe. The higher the score, the worse the fatigue.
Researchers saw a high prevalence of “severe” to “very severe” fatigue for each subscale. Overall, patients reported a significant prevalence of fatigue: 60% on the general scale, 55.8% for physical, 41.7% for reduced activity, 32.5% for reduced motivation, and 27.5% for mental.
Participants were divided into two groups based on their body mass index (BMI, or weight to height ratio): obese (BMI equal or higher than 30 kg/m2) and less than obese (BMI equal or lower than 29.9 kg/m2). A higher total fatigue score was observed in the obese group (mean 64.41) compared with the less than obese group (mean 53.34), indicating a correlation between elevated BMI and worse fatigue.
Currently available treatment options for PH work in different ways: for example, by helping the production of natural vasodilators in the lungs (phosphodiesterase inhibitors); by preventing the narrowing of arteries (endothelin receptor blockers); and by relaxing the blood vessels in the lungs (prostacyclins).
Researchers found that PH patients treated with dual therapy using a phosphodiesterase inhibitor and an endothelin receptor blocker scored the lowest on all fatigue subscales, except mental fatigue.
However, triple therapy with a phosphodiesterase inhibitor, endothelin receptor blocker, and prostacyclin increased the scores of the general, physical, and reduced activity scales by more than six points. This result may be due to the higher side effects related to the prostacyclin class of therapies, the researchers hypothesized.
“Continued investigations into fatigue assessment may provide important data regarding the utility of fatigue as a discriminatory measure in pulmonary hypertension and, very importantly, development of targeted interventions to alleviate and/or manage fatigue,” they concluded.