Fatigue occurs in about half of COPD patients. The contributing factors of fatigue in COPD remain unclear and have hardly been studied in an integrated analysis.

Aim of this study is to identify contributing factors of fatigue in COPD.

In this observational study, clinically stable COPD patients from primary and secondary care were assessed for fatigue (Checklist Individual Strength Subjective Fatigue; CIS-Fatigue), other symptoms, and personal-, COPD-related-, physical-, psychological-, and systemic factors (Figure). Multivariate stepwise regression analyses were performed for each group of potential factors, followed by a final multivariate (enter) model with all identified factors (yellow in Figure).

247 COPD patients (67±8y, 60% male, FEV1 57±21%pred, 27% GOLD E) were included. Severe fatigue (CIS-Fatigue ?36 points) was present in 51%. Separate models per group of factors identified marital status, Charlson comorbidity score, diffusion capacity, number of moderate exacerbations in the last year, dyspnea, sleep quality, pain, exercise capacity, fatigue-catastrophizing, depressive symptoms, calcium, and leukocyte count (yellow in Figure). The final regression model explained 46.5% of variance in fatigue with dyspnea, sleep quality, fatigue-catastrophizing, and pain as significant contributing factors (bold in Figure).

Treatment of the final contributing factors of fatigue may potentially reduce fatigue in COPD patients.