Patients with IPF report greater fatigue, shortness of breath after hospitalization

Key takeaways:

• Researchers observed a significant increase in Fatigue Severity Score after patients with IPF experienced hospitalization.
• The same was true when assessing UCSD Shortness of Breath Questionnaire scores.

BOSTON — Fatigue and shortness of breath among patients with idiopathic pulmonary fibrosis got worse after being hospitalized, according to data presented at the CHEST Annual Meeting.

“Clinicians should pay attention to how ILD patients feel and function after a hospitalization,” Christopher S. King, MD, FCCP, chief of cardiovascular critical care, associate medical director of the transplant and advanced lung disease program, and system director of respiratory care services at Inova Fairfax Hospital, told Healio.

“They should also consider interventions such as physical therapy/pulmonary rehabilitation and palliative care consultations that may decrease the impact of hospitalizations,” King, who is also director of the Pulmonary Fibrosis Foundation (PFF) Center, continued.

Using the PFF registry, King and colleagues assessed questionnaire responses from 123 patients with IPF who had been hospitalized to determine how hospitalization impacts fatigue via the Fatigue Severity Score (FSS), cough via the Leicester Cough Questionnaire (LCQ) and shortness of breath via the UCSD Shortness of Breath Questionnaire.

Within the total cohort, more patients had longer (≥ 5 days) vs. shorter (< 5 days) hospital stays (92 patients vs. 31 patients). Additionally, respiratory-related hospitalizations accounted for over half of the study population (72).

A higher FSS signaled worse fatigue, and researchers observed a significant increase in this score after patients experienced hospitalization (mean before, 4.3 vs. after, 4.8; P = .006).

Greater shortness of breath was also signaled by higher scores on the UCSD Questionnaire. Before hospitalization, the mean score was 43.9, and this significantly went up to 49.2 after hospitalization (P = .0059), according to the abstract.

In contrast, the mean LCQ score before hospitalization did not significantly differ from the mean score after hospitalization (16.7 vs. 16.4).

Among patients who stayed in the hospital for longer than 5 days, researchers continued to find significant rises in FSS after vs. prior to hospitalization (mean, 5.1 vs. 4; P = .0004), as well as in UCSD Shortness of Breath Questionnaire scores after vs. before hospitalization (mean, 49.3 vs. 38.9; P = .0054).

Notably, the mean LCQ score significantly went down between the two time periods (17.4 to 16.3; P = .05), signaling worsening cough, but did not “meet minimally important clinical difference,” according to the abstract.

In the set of patients with respiratory-related hospitalizations, the mean UCSD Shortness of Breath Questionnaire score significantly rose from 49.7 before hospitalization to 55.4 after hospitalization (P = .042). Researchers noted that both scores were higher than those observed in the total cohort.

The change in mean FSS between the two time periods in the respiratory-related hospitalization cohort was also significant, going from 4.4 before hospitalization to 4.9 after (P = .0199). Both scores resembled those observed above in the total cohort, according to the abstract.

“I think the study validates what we would expect,” King told Healio. “Hospitalizations are meaningful clinic events that impact the quality of life of our patients.

“It is difficult to know how much of the decreased quality of life is from the progression of underlying disease that leads to hospitalization vs. the effects of hospitalization on conditioning, etc,” King continued. “It is an important distinction as we may be able to mitigate some of the adverse effects if deconditioning is playing a role.”

King told Healio he already has plans for future studies on this topic.

“I need to further analyze the data from the registry to see if these decrements in quality of life are sustained or if they ultimately recover,” King said. “I also plan to study the relationship between hospitalizations and lung function in IPF patients.”

For more information:

Christopher S. King, MD, FCCP, can be reached at christopher.king@inova.org.