Photo Credit: Liubomyr Vorona

Patients with severe asthma report fatigue, sleep disturbances, physical inactivity, and reduced work productivity as some of the most bothersome impacts.

Patients with severe asthma report fatigue, sleep disturbances, physical inactivity, and reduced work productivity as some of the most bothersome outcomes associated with their condition. However, these issues are notably underexplored in studies, according to an article published in European Respiratory Review.

“Overall, this review highlights significant gaps in understanding patient-centered aspects of severe asthma, urging for research on comprehensive interventions to improve patients’ lives,” wrote corresponding author Lianne Ten Have and colleagues.

According to the review, as many as 90% of patients with asthma report fatigue, and as many as three-quarters of patients with severe asthma report difficulty sleeping. Both fatigue and sleep are associated with asthma control, yet the cause-and-effect relationship is unclear.

Asthma control and dyspnea scores explain less than one-third of the variance in fatigue scores, and fatigue shows only moderately significant links with scores on the Asthma Quality of Life Questionnaire. This suggests that fatigue differs conceptually from asthma control and quality of life (QoL).

Meanwhile, the relationship between poor sleep and asthma is complex, with medication side effects and comorbid conditions complicating the picture.

“Of note, while treatment improving asthma control and optimizing comorbid factors may alleviate sleep disturbances in some patients, it does not universally resolve them,” the authors wrote. “This suggests a bidirectional relationship where asthma may impact sleep, but poor sleep itself may also cause or worsen the disease.”

Physical inactivity, too, is often a consequence of and a contributing factor to poor asthma control. Nevertheless, pulmonary rehabilitation interventions and programs have been shown to increase physical activity, improve asthma outcomes, and improve QoL. The review characterized physical inactivity as a treatable trait and advised replacing sedentary behavior with light physical activity at first.

“Starting a supervised intervention may remove the initial barrier to exercise experienced by some patients,” the authors wrote. “Patients with severe asthma may benefit most from PA [physical activity] behavior that can be sustained in order to improve asthma control and eventually their QoL.”

Reduced productivity at work and increased absenteeism are also common in patients with asthma, and asthma control is a primary factor.

The review reported that biologic therapies show a potential to help; however, their effects on physical activity, fatigue, and sleep require more investigation.