Fatigue in Adults with Chronic Obstructive Pulmonary Disease Before and During a Pandemic

Abstract

Background: Over half of the 11 million people living with chronic obstructive pulmonary disease (COPD) suffer from debilitating fatigue almost every day. There is limited evidence on known mechanisms of COPD-related fatigue and factors that influence fatigue. Purpose: The purposes of this dissertation were to 1) survey the findings of existing literature on correlates and underlying potential mechanisms of COPD-related fatigue and test these findings in a model of situational factors, psychologic and physiologic factors in adults with COPD-related fatigue and physical functioning and 2) explore the lived experience of COPD-related fatigue during the COVID-19 pandemic. Methods: Chapter 2 is a scoping review to identify relevant studies on potential mechanisms and influential factors of COPD-related fatigue based on the Theory of Unpleasant Symptoms. The second manuscript is a descriptive correlational study that presents a path model from a population-based study on the relationships between physiologic, psychologic, and situational factors with fatigue and physical function. The third manuscript is a qualitative research study using a phenomenological descriptive approach and collected data from adults living with COPD and fatigue during the COVID-19 pandemic with attention to the influence of social support and physical function. Results: In Chapter 2, a conceptual model of COPD-fatigue was established from the scoping review based on the TOUS of physiologic, psychologic and situational factors contributing to COPD fatigue. When testing the model, depression (0.181, p<0.001), smoking (0.541, p=0.019), and stress (0.073, p=0.038) all had significant direct effects on fatigue. Social support (0.967, p=.016) and sleep (0.577, p=0.010) impacted physical functioning, but not fatigue. In Chapter 4, three main themes were found from interviews pertaining to the experience of fatigue during the COVID-19 pandemic: experience of general fatigue from the COVID-19 pandemic, changes in response to pandemic, and psychologic and social mentality. Conclusion: These findings lay groundwork for research on influential factors of COPD-related fatigue and physical function. Interventions geared toward reducing depression and stress management may reduce COPD related fatigue. There remains a gap on physiologic mechanisms of COPD fatigue that should be addressed in future studies.