Fatigue in Dutch children with severe asthma: an under recognized symptom

<bold>Aim:</bold> To explore the burden of fatigue in severe pediatric asthma and assess its associations with clinical characteristics, comorbidities, and medication use. Method This study, conducted within the Paediatric Asthma Non-Invasive Diagnostic Approaches (PANDA) study, included children aged 6-17 treated according to GINA guidelines step ≥3. Self-reported fatigue was measured using the Paediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS). Fatigue levels were compared to a healthy Dutch peer group (n=326) using adjusted z-scores and one-sample t-tests. The influence of various factors on fatigue was examined via independent t-tests, including demographics, lung function, asthma exacerbations, comorbidities (obesity, eczema, food allergy, dysfunctional breathing, obstructive sleep apnea syndrome (OSAS)), and medication use. Fatigue's correlation with self-reported asthma control and quality of life was assessed through linear regression models. <bold>Results:</bold> 78 severely asthmatic children (mean age 11.8±3.1 years, 64.1% male) reported significantly more fatigue than healthy peers (z-score -0.73 ±1.58, p<.001), with an average PedsQL-MFS score of 68.4±9.4 (range 0-100). Patients with OSAS, dysfunctional breathing, a prescription for Montelukast, or nasal corticosteroids showed significantly more fatigue (p<.050). Higher fatigue scores were significantly associated with lower asthma-related quality of life (β=0.466, p<.001) and worse asthma control (β=0.275, p=.033), explaining 46.2% of the variance. <bold>Conclusion:</bold> Fatigue significantly contributes to the disease burden of children with severe asthma, warranting further research to assess the impact of personalized interventions on symptom reduction.