Extra-respiratory symptoms in patients hospitalized for a COPD exacerbation: Prevalence, clinical burden and their impact on functional status

Introduction In COPD management, the improvement of the health status by alleviating respiratory symptoms is among the main aims. However, little is known on the prevalence and burden of extra-respiratory symptoms which can also be distressing especially during a COPD exacerbation. Objectives To evaluate the prevalence of extra-respiratory symptoms and their impact on health and functional statuses in patients hospitalized for a COPD exacerbation. Methods Health status was evaluated with the COPD Assessment Test (CAT), functional status with Karnofsky index, and presence and severity of respiratory symptoms were evaluated with Edmonton Symptom Assessment Scale (ESAS). Results In a sample of 47 patients, fatigue was found to be the most prevalent 95.7% followed by pain 74.5%, lack of appetite 72.3%, depression and anxiety (each in 63.8%), drowsiness 59.6% and nausea 31.9%. The concomitant presence of an increasing number of symptoms (three, four, five, six or seven) was individually associated with worse health status or of functional status (eg, CAT score in patients with three most prevalent symptoms, fatigue, pain and lack of appetite 29.6 vs 25.1, P = .006 in patients without them; Karnofsky index scores in patients with the four most prevalent symptoms 52 vs 65.6, P = .001). Linear regressions confirmed that the increase in the number of concomitant extra-respiratory symptoms significantly correlated with the worsening of health/functional status. In conclusion, the burden of extra-respiratory symptoms in patients with hospitalized for a COPD exacerbation is significant and impact significantly on health/functional status.