Circadian rhythm of COPD symptoms in clinically based phenotypes. Results from the STORICO Italian observational study

Abstract

Background Chronic Obstructive Pulmonary Disease (COPD) encompasses various phenotypes that severely limit the applicability of precision respiratory medicine. The present investigation is aimed to assess the circadian rhythm of symptoms in pre-defined clinical COPD phenotypes and its association with health-related quality of life (HR-QoL), the quality of sleep and the level of depression/anxiety in each clinical phenotype. Methods The STORICO (NCT03105999) Italian observational prospective cohort study enrolled COPD subjects. A clinical diagnosis of either chronic bronchitis (CB), emphysema (EM) or mixed COPD-asthma (MCA) phenotype was made by clinicians at enrollment. Baseline early-morning, day-time and nocturnal symptoms (gathered via the Night-time, Morning and Day-time Symptoms of COPD questionnaire), HR-QoL (via the St. George’s Respiratory Questionnaire), anxiety and depression levels (via the Hospital Anxiety and Depression Scale), quality of sleep (via COPD and Asthma Sleep Impact Scale), physical activity (via the International Physical Activity Questionnaire) as well as lung function were recorded. Results 606 COPD subjects (age 71.4 ± 8.2 years, male 75.1%) were studied. 57.9, 35.5 5.3 and 1.3% of the sample belonged to the CB, EM, MCA and EM + CB phenotypes respectively. The vast majority of subjects reported early-morning and day-time symptoms (79.5 and 79.2% in the CB and 75.8 and 77.7% in the EM groups); the proportion suffering from night-time symptoms was higher in the CB than in the EM group (53.6% vs. 39.5%, p = 0.0016). In both CB and EM, indiscriminately, the presence of symptoms during the 24-h day was associated with poorer HR-QoL, worse quality of sleep and higher levels of anxiety/depression. Conclusions The findings highlight the primary classificatory role of nocturnal symptoms in COPD. Trial registration Trial registration number: NCT03105999, date of registration: 10th April 2017.

A Real-World Study on the Day and Night-Time Symptoms Among Greek COPD Patients Who Recently Initiated Treatment with Dual Bronchodilation: The DANICO Study

“… 2 , 3 Therefore, a more detailed approach regarding the appropriate classification of COPD patients and their treatment beyond the GOLD recommendations seems necessary and this notion is increasingly discussed among COPD specialists worldwide. 4 …”

The Relationship between Experienced Respiratory Symptoms and Health-Related Quality of Life in the Elderly with Chronic Obstructive Pulmonary Disease

“…Similarly, in the study by Moy et al, the presence of shortness of breath was a more important determinant of quality of life compared to the forced expiratory value in one second (FEV1) [35]. In addition, two other studies evidenced that severe respiratory symptoms were associated with poor HRQoL in patients with COPD [34,36].…”

“…In patients with COPD, medications including bronchodilators, corticosteroids, and combination therapies are started to control respiratory symptoms, prevent exacerbation, and improve their quality of life. However, it has been shown that a large number of people with COPD sometimes experience respiratory symptoms, despite the chronic use of several medications [34]. Moreover, it was documented that the inhaled corticosteroids are the secondary cause of osteoporosis in elderly patients with COPD [15], which can have a negative impact on their quality of life.…”

Clinical Evolution and Quality of Life in Clinically Based COPD Chronic Bronchitic and Emphysematous Phenotypes: Results from the 1-Year Follow-Up of the STORICO Italian Observational Study

“…All subjects aged ≥50, current or ex-smokers with a smoking history of at least 10 pack-years, with a diagnosis of COPD (defined as post-bronchodilator FEV1/FVC <0.7 with the presence of symptoms) and in stable conditions (ie with no major changes in the therapy) for at least 12 months according to the GOLD 2014 (stages A to D) 7 were enrolled. [11][12][13] Patients participating in a clinical trial and those who had changed their COPD treatment regimen in the 3 months prior to enrolment were excluded, as were patients with exacerbations during the month prior to enrollment. Also, patients under continuous use of oxygen therapy or suffering from asthma, sleep apnea syndrome or other chronic diseases that reduced life expectancy to less than 3 years (Charlson index > 3) were excluded.…”