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Relationship between perceived and neuromuscular fatigue in COPD patients with chronic respiratory failure with long-term oxygen therapy: a cross-sectional study

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European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate perceived fatigue (PF) and neuromuscular fatigue (NMF) in patients with COPD and chronic respiratory failure (CRF) on long-term oxygen therapy (CRF-COPD group), and the relationships between PF, NMF, patient’s characteristics, comparing severe patients with COPD to patients without CRF (COPD group).

Methods

This cross-sectional study compared 19 CRF-COPD patients with 10 COPD patients attending a rehabilitation program. PF was determined by Fatigue Severity Scale (FSS), while dyspnea by the Barthel Dyspnea Index (BDI). We assessed quadriceps NMF via electrical nerve stimulation during and following a Maximal Voluntary Contraction (MVC) detecting changes after a Constant Workload Cycling Test (CWCT) at 80% of the peak power output at exhaustion.

Results

CRF-COPD patients showed higher PF (+ 1.79 of FSS score, p = 0.0052) and dyspnea (+ 21.03 of BDI score, p = 0.0023) than COPD patients. After the fatiguing task and normalization for the total work, there was a similar decrease in the MVC (CRF-COPD −1.5 ± 2.4 vs COPD −1.1 ± 1.2% baseline kJ−1, p = 0.5819), in the potentiated resting twitch force (CRF-COPD −2.8 ± 4.7 vs COPD −2.0 ± 3.3% baseline kJ−1, p = 0.7481) and in the maximal voluntary activation (CRF-COPD −0.1 ± 3.9 vs COPD −0.9 ± 1.2 −2.0 ± 3.3% baseline kJ−1, p = 0.4354). FSS and BDI were closely related (R = 0.5735, p = 0.0011), while no correlation between PF and NMF was found.

Conclusion

Patients with CRF-COPD develop higher levels of perceived fatigue and dyspnea than patients with COPD; while neuromuscular fatigue is similar, suggesting a mismatch between symptoms and neuromuscular dysfunction.

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Abbreviations

6MWT:

6 Minute Walk Test

ABG:

Arterial Blood Gas

ADL:

Activity of Daily Living

BDI:

Barthel Dyspnea Index

BMI:

Body Mass Index

CIRS:

Cumulative Illness Rating Scale

COPD:

Chronic obstructive pulmonary disease

CRF:

Chronic respiratory failure

CWCT:

Constant Workload Cycling Test

FEV1 :

Forced Expiratory Volume in the 1st second

FiO2 :

Inspiratory Fraction of Oxygen

FSS:

Fatigue Severity Scale

FVC:

Forced Volume Capacity

GOLD:

Global Initiative for Chronic Obstructive Lung Disease

HR:

Heart Rate

LTOT:

Long-term oxygen therapy

MAP:

Mean Arterial Pressure

MVA:

Voluntary Muscle Activation

MVC:

Maximal Voluntary Contraction

NMF:

NeuroMuscular fatigue

O2 :

Oxygen

PaCO2 :

Arterial Carbon Dioxide Partial Pressure

PaO2 :

Arterial Oxygen Partial Pressure

PF:

Perceived fatigue

PPO:

Peak Power Output

Qtwpot:

Potentiated quadriceps twitch force

RPE:

Rate of Perceived Exertion

RV:

Residual Volume

SPO2 :

Arterial Oxygen Saturation

Tlim:

Time to exhaustion of exercise

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Acknowledgements

The Authors thank all Respiratory Rehabilitation physiotherapists of the Institute of Lumezzane (BS) of Istituti Clinici Scientifici Maugeri IRCCS, who treated the patients enrolled in this study, Rosemary Allpress for English revision, and Adriana Olivares for technical assistance and editing.

Funding

This work is a sub-analysis of data from two studies conducted in our Institute: CE 2288, funded by 5 × 1000 grant of the Italian Ministry of Health, related to training in COPD and CRF patients; and CE 2241, supported by “Ricerca Corrente” funding of the Ministry of Health, related to strength training in non-hypoxemic COPD patients.

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Authors and Affiliations

  1. Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy

    Mara Paneroni, Michele Vitacca, Beatrice Salvi & Manuela Saleri

  2. Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Lumezzane, 25065, Brescia, Italy

    Laura Comini

  3. Department of Neuroscience, Biomedicine, and Movement Science, Section of Movement Science, University of Verona, 37134, Verona, Italy

    Federico Schena & Massimo Venturelli

  4. Department of Internal Medicine Section of Geriatrics, University of Utah, Salt Lake City, UT, 84132, USA

    Massimo Venturelli

Authors
  1. Mara Paneroni
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  2. Michele Vitacca
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  3. Laura Comini
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  4. Beatrice Salvi
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  5. Manuela Saleri
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  6. Federico Schena
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  7. Massimo Venturelli
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Contributions

The contributions of the author were as follows: conceptualization and methodology, MP, MV; validation, MP; formal analysis, MP; investigation, MS, BS; data curation, BS, MS; writing—original draft preparation, MP, MV, MV; writing-review and editing, MP, MV, MV, LC, BS, MS, FS; supervision, MV, FS; project administration, MP, MV.

Corresponding author

Correspondence to Mara Paneroni.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the ICS Maugeri (Pavia, CE 2288 and 2241).

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Communicated by Susan Hopkins .

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Paneroni, M., Vitacca, M., Comini, L. et al. Relationship between perceived and neuromuscular fatigue in COPD patients with chronic respiratory failure with long-term oxygen therapy: a cross-sectional study. Eur J Appl Physiol 122, 2403–2416 (2022). https://doi.org/10.1007/s00421-022-05021-2

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