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Fatigue in severe pediatric asthma patients: Results of the PANDA study
Yoni E van Dijk1,2,3,4, Valerie S L Keuker1, Simone Hashimoto1,2
1Department of Paediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.
Insights
Children with severe asthma experience significantly higher fatigue levels than their peers. Fatigue is linked to quality of life, symptom control, and breathing patterns, suggesting it should be a key treatment focus.
Area of Science:
- Pediatric pulmonology
- Clinical research
- Asthma management
Background:
- Fatigue is a prevalent symptom in clinical practice, yet its impact on children with severe asthma remains understudied.
- Research on fatigue in pediatric severe asthma is notably absent, highlighting a gap in understanding this symptom's burden.
Purpose of the Study:
- To investigate the prevalence and severity of fatigue in children diagnosed with severe asthma.
- To identify clinical factors and patient-reported outcomes associated with fatigue in this population.
Main Methods:
- An observational cohort study involving 78 Dutch children (6-17 years) with severe asthma (PANDA cohort).
- Self-reported fatigue was measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL™-MFS).
- Linear regression analyses were employed to compare fatigue levels with a general pediatric population and to identify associated factors including asthma attacks, comorbidities, medication, pulmonary function, symptom control, and quality of life (QoL).
Main Results:
- Children with severe asthma reported significantly higher fatigue levels compared to the general pediatric population (mean difference in z-score: -0.68).
- Prevalence of "fatigued" and "severely fatigued" was higher in the severe asthma group (28.2% and 15.4%) versus the general population (14.0% and 3.4%).
- Asthma-related QoL (β=0.77), symptom control (β=0.56), and dysfunctional breathing patterns (β=-0.36) were most strongly associated with fatigue scores in pediatric asthma patients.
Conclusions:
- Fatigue is a common and significant symptom experienced by children with severe asthma.
- Fatigue in this population is associated with multiple clinical factors and impacts patient-reported outcomes, including quality of life and symptom control.
- Addressing fatigue should be considered a crucial therapeutic target in the management of severe pediatric asthma.
Background:
Fatigue is a commonly reported clinical symptom, yet research on fatigue in children with severe asthma is missing. We aimed to explore the extent of fatigue in severe pediatric asthma and identify associated factors.
Method:
This study was conducted within the Pediatric Asthma Non-Invasive Diagnostic Approaches (PANDA), an observational cohort of 6- to 17-year-old Dutch children with severe asthma. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL™-MFS) was used to measure self-reported fatigue. Fatigue levels were compared with a general pediatric Dutch population using linear regression, and quantifying the prevalence of "fatigued" (-2 < Standard deviations [SD] ≤ -1) and "severely fatigued" (SD ≤ -2) children. Secondly, we performed linear regression analyses to explore whether fatigue levels were independently associated with asthma attacks, comorbidities, medication, pulmonary function, symptom control, and asthma-related quality of life (QoL).
Results:
Severe pediatric asthma patients (n = 78, mean age 11.8 ± 3.1 years) reported significantly more fatigue than Dutch peers (n = 328, mean age 11.8 ± 3.2 years) mean difference in z-score: -0.68; 95%CI -0.96, -0.40. In the severe asthma group, 28.2% scored as "fatigued" and 15.4% as "severely fatigued," compared with 14.0% and 3.4% in the general population. In pediatric asthma patients, asthma-related QoL (β = 0.77, p < .01, ΔR2 = .43), symptom control (β = 0.56, p < .01, ΔR2 = .24) and a dysfunctional breathing pattern (β = -0.36, p < .01, ΔR2 = .12) were most strongly associated with fatigue scores.
Conclusion:
Fatigue is a common symptom in children with severe asthma and is associated with multiple clinical factors and patient-reported outcomes. It should be considered as an important treatment target.
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