Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by intermittent exacerbations, which leads to substantial morbidity and mortality. Chronic cough and sputum production are significant but variable symptoms in COPD, but their effects on exacerbation frequency have not been well described. Methods: We analyzed 52 stable outpatients in Phase II of the Pennsylvania Study of COPD Exacerbations (PA−SCOPE) with severe airflow obstruction (FEV1 <50%). Patients documented daily symptoms of cough, wheeze, breathlessness, sputum quantity, color, and consistency, and upper respiratory tract infectious symptoms in semiquantitative scales, as well as peak flow for up to 2 years. Exacerbation presence and severity was defined based on a daily index of symptoms. Patients were divided into tertiles based on their average sputum symptom indices. Percent emphysema in a subset of these patients (n=23, 8 in tertile 1, 6 in tertile 2, 9 in tertile 3) was analyzed using 3D Slicer v2.8. Data were analyzed using ANOVA and Chi−square test.

Rationale: Seasonal variability of daily chronic obstructive pulmonary disease (COPD) symptoms has not been demonstrated. Methods: COPD patients enrolled in Pennsylvania Study of COPD exacerbations (PA−Scope) a randomized prospective study using telemedicine to administer algorithm based outpatient therapy in response to changes in daily symptoms and peak expiratory flows versus standard care. Patient enrollment and data collection began 6/05 ending 5/08. Each patient electronically submitted daily self−evaluated symptoms of cough, breathlessness, wheeze, upper respiratory symptoms, sputum quantity, color and consistency for up to 2 years. Severity of daily symptoms was defined using a weighted daily symptom score. Tertiles of score severity were labeled mild, moderate and severe. Seasonal trends in daily respiratory symptoms were determined using smoothed locally weighted regression of daily symptom scores for each tertile of symptom severity. Results: 78 patients (f=46), age 64±7.34 years had a mean FEV1 of 32.85%±14.7. Symptoms were reported on 17,311 out of 23,259 (74.43%) potential patient reporting days. 1.27% reporting days were symptom free, 31.12% mild, 38.02% moderate, 29.61% severe.[figure1]Conclusion: Severe COPD patients self−report moderate and severe respiratory symptoms on 67% of days; very few were ever asymptomatic. Mild, moderate and severe COPD symptoms were most common in December−March and least common in June−August. This abstract is funded by: PA SCOPE PA DOH 02−07−20. Am J Respir Crit Care Med 179;2009:A5353 Internet address: www.atsjournals.org Online Abstracts Issue

No abstract

No abstract

No abstract