Severe fatigue in uncontrolled asthma: causes and solutions

Published online September 3, 2024

Fatigue is a significant and often distressing symptom for people living with severe asthma. It is commonly experienced by patients who report that it greatly impacts their daily lives and overall quality of life. Despite being frequently reported, fatigue is often overlooked in asthma care. Currently, there is limited information available about how common fatigue is in severe asthma, what factors contribute to its severity, and whether better asthma control can help reduce fatigue. Studying these factors could lead to better strategies for managing both asthma and fatigue, resulting in improved patient-centered asthma management.

In a study by Fieten et al., published in The Journal of Allergy and Clinical Immunology: In Practice, researchers conducted a retrospective observational study that analyzed data collected between 2007 and 2018. The study examined 420 patients with uncontrolled severe asthma who were referred to an alpine altitude clinic for specialized pulmonary rehabilitation. The rehabilitation program lasted eight weeks and included comprehensive assessments of the patients, as well as medical, behavioral, and exercise-based interventions. The primary goal of the study was to evaluate the severity of fatigue, identify the factors associated with it, and examine the program’s effectiveness in reducing fatigue.

At the start of the rehabilitation, 91% of the patients reported severe fatigue. Poor asthma control and sleep disturbances were identified as key contributors to the severity of fatigue. The prevalence of severe fatigue significantly decreased after rehabilitation, but 27% of patients reported persistent severe fatigue. Patients who used oral corticosteroids daily experienced sleeping problems, were older, and had more severe fatigue at the start were more likely to continue suffering from severe fatigue after the program. While the rehabilitation program was effective in improving both asthma control and fatigue for most patients, additional strategies may be needed for those with persistent fatigue. Addressing sleep issues and incorporating behavioral therapies targeting fatigue could potentially lead to better outcomes for those with persistent severe fatigue. Asthma specialists should routinely assess fatigue levels and explore alternative approaches for patients with ongoing severe fatigue.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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