D2.95 - Targeted CBT for persistent severe fatigue in a pulmonary rehabilitation setting: a case control study

Fatigue is an important extrapulmonary trait in severe asthma, which often resolves after pulmonary rehabilitation at altitude. Cognitive behavioral therapy (CBT) is a recommended treatment modality for persistent fatigue that may be applied in a short, targeted form. This study aims to assess the effectiveness of targeted CBT in reducing fatigue among patients with severe asthma in a pulmonary rehabilitation setting.

A matched case-control study was conducted. Patients who received targeted CBT (max 5 sessions) between 2021 and 2024 were identified as cases (n=15). Controls (n=15) who did not receive targeted CBT were matched to cases on age, sex, and baseline fatigue severity. Exposure to targeted CBT was verified through clinical records. Subjective fatigue (CIS-fatigue), asthma control (ACQ6), health-related quality of life (AQLQ or SAQ), sino-nasal outcomes (SNOT), oral corticosteroid use (OCS), and exercise capacity (six minute walk distance (6MWD) or incremental shuttle walk test (ISWT)) were assessed. Paired sample analysis was conducted to compare fatigue scores and asthma outcomes at discharge between cases and controls.

A total of 15 cases and 15 controls, 1:1 matched on sex, age, and baseline fatigue severity (CIS-F score), were included. Baseline characteristics were similar between cases and controls respectively: 80% of participants were female, age was median(IQR) 52(39;64) and 52(41;63) years, fatigue (CIS-F) was median(IQR) 53(48;55) and 51(47;55), asthma control (ACQ6) was median(IQR) 2.8(2.2;3.5) and 3.0(2.0;3.8). Following targeted CBT intervention, cases demonstrated similar fatigue at discharge median(IQR) 32(19;42) compared to controls median(IQR) 27(19;36), p=0.530. Other asthma outcomes demonstrated no significant differences between cases and controls at the end of pulmonary rehabilitation.

Patients with severe asthma who received targeted CBT in a pulmonary rehabilitation setting reported similar fatigue after rehabilitation compared to matched controls. However, we were unable to distinguish acute from persistent fatigue in the control group, whereas all treated cases reported persistent fatigue. Acute fatigue may resolve with improved asthma control, while persistent fatigue needs targeted management to address contributing factors. Further research that takes fatigue chronicity into account is needed to confirm these findings and find effective interventions for patients to reduce severe fatigue.