by Phyllis Hanlon, Contributing Writer

Symptoms that are commonly experienced by people with pulmonary hypertension (PH) — such as shortness of breath, light-headedness, chest pain, swelling and fatigue — can negatively impact their quality of life. Fatigue – lack of energy or an increased sense of effort with routine tasks – is reported in more than half of people with PH. While patients often report these symptoms to be as disabling as shortness of breath, fatigue is clinically recognized less frequently. However, a recently published study* conducted by Todd M. Tartavoulle, M.N., CNS-BC, and a team of researchers investigated fatigue and its symptoms in persons with PH.

Data for this study was collected in the Pulmonary Hypertension Association’s (PHA) Research Room at PHA’s 2014 International PH Conference and Scientific Sessions in Indianapolis, Ind. The authors chose to have PH patients complete the multidimensional fatigue inventory (MFI)-20 questionnaire as a fatigue measurement tool; the inventory provides information about different types of fatigue, as well as the different levels of its severity. The MFI-20 measures fatigue in the areas of:

  • General fatigue.
  • Physical fatigue.
  • Reduced activity.
  • Reduced motivation.
  • Mental fatigue.

A total of 120 participants with World Health Organization (WHO) Group 1 PH (pulmonary arterial hypertension, or PAH) completed the study. Based on the MFI-20 results, researchers calculated the percentage of the 120 participants who have “severe” or “very severe” fatigue by category.

General fatigue 60 percent
Physical fatigue 58.8 percent
Reduced activity 41.7 percent
Mental fatigue 32.5 percent
Reduced motivation
27.5 percent

A high number of patients reported experiencing “severe” to “very severe” fatigue within each of the measured types of severity, with the most patients suffering from general fatigue, physical fatigue and reduced activity.

Certain factors proved to be good indicators of high risk for fatigue associated with PH, such as a high body mass index (BMI), high New York Heart Association (NYHA) functional class and oxygen use. Medications also were associated with differences in reported fatigue. Researchers found that patients on a combination of PDE-5 inhibitors (e.g., sildenafil and tadalafil) and an endothelin receptor antagonist (e.g., ambrisentan, bosentan and macitentan) had lower fatigue scores across all types measured except for mental fatigue. However, the addition of a prostacyclin therapy was related to higher reported general and physical fatigue, as well as lower activity scores. The researchers explained that this could be because prostacyclin therapies have a significant number of side effects and can be burdensome to manage. Another explanation may be that patients on combination therapy, especially prostacyclin therapy, frequently have more severe disease that could lead to more fatigue.

The researchers assert that fatigue should be considered in the care of patients with PH in order to improve quality of life and health outcomes. Additional research is needed to understand more about the impact of fatigue in PH patients and to potentially identify opportunities to intervene to alleviate this debilitating symptom.

*This study was supported by United Therapeutics Corporation and Tulane University School of Medicine.