Respiratory, Emotional Symptoms May Decrease Quality of Life in IPF Patients

A decrease in health-related quality of life (HRQoL) in people with idiopathic pulmonary fibrosis (IPF) is mainly associated with respiratory and emotional symptoms, a study shows.

Routine assessment of these symptoms is important, as they may be related to other ones affecting HRQoL, researchers say.

The study, “Factor analysis identifies three separate symptom clusters in idiopathic pulmonary fibrosis,” was published in the European Respiratory Journal Open Research.

People with IPF can experience a wide range of symptoms that can worsen their HRQoL. However, few studies on IPF symptoms, their interrelationship, and their impact on HRQoL have been conducted, which makes symptom-centered healthcare challenging.

To fill these gaps, a team of researchers in Finland analyzed symptom factors in a cohort of IPF patients.

In total, the study involved 245 patients (mean age of 74 years) from the FinnishIPF registry, who were asked to fill two questionnaires: the Edmonton Symptom Assessment System and RAND 36-Item Health Survey. The first one assesses symptoms and arranges them into groups to determine the correlation between them. The second evaluated the link between those groups of symptoms and the dimensions of HRQoL, including mental health, vitality, bodily pain, general health, and physical functioning.

Three main symptom groups were found: emotional group (related to depression, anxiety, insomnia, loss of appetite, and nausea), pain group (linked to pain at rest or in movement), and respiratory symptoms group (associated with breathlessness, cough, fatigue, and loss of well-being).

The correlation level within each group was then assessed. The score was 0.85 in the emotional group, and 0.78 for the pain group and also for the respiratory symptoms group. A correlation score of 0.70 and above is good, 0.80 and above is better, and 0.90 and above is best, meaning there was strong internal correlation inside the groups.

Significant results were also found in the correlation between the groups of symptoms and HRQoL. In this case, the lower the score, the stronger the correlation. The emotional group was found to have the strongest correlation with mental health (correlation coefficient of minus 0.69) and vitality (correlation coefficient of minus 0.63).

“This is in line with previous studies, which show that depression and anxiety impair HRQoL in IPF patients,” the team wrote. “However, the emotional factor also correlated with vitality in our study. Vitality not only reflects physical tiredness, but also mental exhaustion, which may explain the correlation between vitality and the emotional factor.”

The respiratory symptoms group was strongly related with vitality (correlation coefficient of minus 0.69), general health (minus 0.64), and physical functioning (minus 0.62), showing the extensive impact of breathlessness on disease progression and well-being.

“Increasing respiratory symptoms impair physical functioning and exercise capacity, which in turn decreases vitality and further impairs physical activity,” the researchers wrote. “This vicious circle of dyspnea [breathlessness] can over time cause patients’ general health to decline.”

The pain group was significantly associated with bodily pain (correlation coefficient of minus 0.72).

Contrary to what was expected, the researchers did not find a strong correlation between pain and respiratory or emotional symptoms, which led them to hypothesize that pain may have another source in IPF patients.

“Because pain is not associated with the respiratory symptoms factor, it may have a mixed etiology (e.g. musculoskeletal pain or some other type of pain not directly associated with IPF) or associated with other comorbidities or ageing,” the researchers wrote.

According to the team, this was the first study to present grouped symptom factors in IPF, where respiratory and emotional symptoms had the greatest impact on HRQoL. Overall, these results emphasize the significant impact that symptoms may have on HRQoL in people with lung diseases.

“In order to improve IPF patients’ general wellbeing and HRQoL, optimal treatment of respiratory symptoms, rehabilitation and psychosocial support are vital, and routine symptom assessment should be a part of everyday clinical practice,” the researchers concluded.