Daily Symptom Variability in Patients With Stable COPD: A Narrative Review

Wu, Maochun; Wang, Zequan; Li, Manman; Li, Kun

doi:10.1177/0193945917705132

Cited by 6 publications

(9 citation statements)

References 41 publications

(97 reference statements)

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“…Findings of the COPVAR study show that GOLD C and D patients perceived different burden of symptoms, levels of variability, and related impact on daily activities. As confirmed recently, patients with stable COPD commonly experience daily symptom variability with the morning being the most troublesome time of the day followed by night 24. It was reported that the proportion of patients with breathlessness increased from nighttime through the morning and into the daytime, whereas coughing and bringing up phlegm or mucus were most common early in the morning 20.…”

Section: Discussionmentioning

confidence: 79%

<p>A Cross-Sectional Study in Patients with Severe COPD to Assess the Perception of Symptom Variability (COPVAR) in the Middle East and Africa</p>

Köktürk¹,

Abuharbid²,

Albanna³

et al. 2019

COPD

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PurposeThis study was performed to assess symptom variability and its impact on morning activities in stable patients with severe COPD in the Middle East and Africa (MEA) countries.Patients and methodsNon-interventional, cross-sectional study (NCT03425760) in patients with severe COPD (GOLD 2015, C, or D categories). Symptom variability was assessed directly by interviewing the patient and using the Global Chest Symptoms Questionnaire (GCSQ). The impact on morning activities was assessed using the Capacity of Daily Living during the Morning (CDLM) and the Morning Activities and Symptoms Questionnaire (MASQ).ResultsA total of 3253 patients (mean±SD age: 64.1±9.5 years, 90.3% males) were enrolled. Overall, 81.6% and 83.4% of patients reported weekly and daily symptom variability, respectively. The number of exacerbations in the previous year, smoking cessation, and COPD GOLD D were the most consistent factors associated with symptom variability. The GCSQ score was significantly higher (p<0.001) in GOLD D than in GOLD C patients at each time during the day. In GOLD D, the mean (±SD) GCSQ score was higher at night (1.6±1.2, p<0.001) and in the morning (1.5±1.0, p<0.001) than in the afternoon (1.3±0.9), suggesting daytime variability of breathlessness and chest tightness. Overall, 60.0% of GOLD D patients (versus 13.6% GOLD C, p<0.0001) had difficulty getting out of bed due to COPD. Patients with symptom variability had significantly more difficulty to get out of bed, especially patients with chest tightness variability (p<0.0001) and wheezing variability (p<0.0001). The CDLM global score was significantly lower (p<0.0001) in GOLD D than in GOLD C patients (3.5±1.1 and 4.6 ± 3.5, respectively). Daily variability in chest tightness and wheezing was also significantly associated with CDLM scores (p<0.0001).ConclusionIn MEA countries, patients with severe stable COPD reported significant daily and weekly symptom variability which affects morning activities, particularly in GOLD D patients.

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Section: Discussionmentioning

confidence: 79%

<p>A Cross-Sectional Study in Patients with Severe COPD to Assess the Perception of Symptom Variability (COPVAR) in the Middle East and Africa</p>

Köktürk¹,

Abuharbid²,

Albanna³

et al. 2019

COPD

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“… 6 - 17 Morning symptoms were reported by 37-81% of the patients in the samples, whereas nighttime symptoms were reported by 25-68%. There are several explanations for this disparity, such as the heterogeneity in study design, 31 the method of assessing symptoms, and behavioral differences between patients in different locations. 18 , 19 , 32 …”

Section: Discussionmentioning

confidence: 99%

“…Regarding the methodological aspects, we emphasize that the present study is one of the few in the international literature in which validated questionnaires were used to evaluate morning and nighttime symptoms. 31 …”

Section: Discussionmentioning

confidence: 99%

Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study

Cukier¹,

Godoy²,

Costa³

et al. 2020

J Bras Pneumol.

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Objective: To analyze symptoms at different times of day in patients with COPD. Methods: This was a multicenter, cross-sectional observational study conducted at eight centers in Brazil. We evaluated morning, daytime, and nighttime symptoms in patients with stable COPD. Results: We included 593 patients under regular treatment, of whom 309 (52.1%) were male and 92 (15.5%) were active smokers. The mean age was 67.7 years, and the mean FEV 1 was 49.4% of the predicted value. In comparison with the patients who had mild or moderate symptoms, the 183 (30.8%) with severe symptoms were less physically active (p = 0.002), had greater airflow limitation (p < 0.001), had more outpatient exacerbations (p = 0.002) and more inpatient exacerbations (p = 0.043), as well as scoring worse on specific instruments. The most common morning and nighttime symptoms were dyspnea (in 45.2% and 33.1%, respectively), cough (in 37.5% and 33.3%, respectively), and wheezing (in 24.4% and 27.0%, respectively). The intensity of daytime symptoms correlated strongly with that of morning symptoms (r = 0.65, p < 0.001) and that of nighttime symptoms (r = 0.60, p < 0.001), as well as with the COPD Assessment Test score (r = 0.62; p < 0.001), although it showed only a weak correlation with FEV 1 (r = −0.205; p < 0.001). Conclusions: Dyspnea was more common in the morning than at night. Having morning or nighttime symptoms was associated with greater daytime symptom severity. Symptom intensity was strongly associated with poor quality of life and with the frequency of exacerbations, although it was weakly associated with airflow limitation.

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“…10,11 In patients with COPD, up to 99% of patients reported symptoms that impaired activities of daily living, and up to 80% reported feeling anxious and/ or depressed. 12,13 Patients with COPD were also 85% more likely to be diagnosed with an anxiety disorder, and twice as likely to be hospitalized for exacerbations when compared to healthy control. [13][14][15][16] In 2009, patients with COPD accounted for approximately 16% of all hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

“…12,13 Patients with COPD were also 85% more likely to be diagnosed with an anxiety disorder, and twice as likely to be hospitalized for exacerbations when compared to healthy control. [13][14][15][16] In 2009, patients with COPD accounted for approximately 16% of all hospitalizations. 11 Other investigators found the combination of COPD and comorbid HF was associated with a 2.8-times greater likelihood of worse quality of life, and a dyspnea burden two to nearly three times greater than those with HF only.…”

Section: Introductionmentioning

confidence: 99%

Airflow limitation more than doubles the risk for hospitalization/mortality in patients with heart failure

Bugajski

Frazier

Moser

et al. 2019

European Journal of Cardiovascular Nursing

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Background: Comorbid chronic obstructive pulmonary disease is found in approximately one-third of patients with heart failure. Survival in patients with chronic obstructive pulmonary disease generally decreases as lung function declines. However, the association between lung function, hospitalization and survival is less clear for patients with heart failure. Aim: The purpose of this study was to determine the predictive power of spirometry measures for event-free survival (combined all-cause hospitalization and/or mortality) in patients with heart failure. Methods: In this secondary analysis of data from three prospective, longitudinal studies, we selected patients with a confirmed diagnosis of heart failure who completed airflow limitation assessment using spirometry measures (n=137): forced vital capacity, forced expiratory volume/second, and forced expiratory volume/second/forced vital capacity. Cox proportional hazards modeling was used to determine the relationship between spirometry and all-cause hospitalization/ mortality with and without adjusting for demographic and clinical covariates over a four-year follow-up period. Results: A majority (74%) exhibited some degree of airflow limitation (forced expiratory volume/second<80% predicted value) and 26 (19%) met the spirometric criterion for chronic obstructive pulmonary disease (forced expiratory volume/ second/forced vital capacity⩽0.70). Cox proportional hazards regression models compared all-cause hospitalization/ mortality between those with and without airflow limitation. Patients with airflow limitation were 2.2 times more likely to be hospitalized or die compared to those without airflow limitations (hazard ratio: 2.20, 95% confidence interval 1.06-4.53, p=0.03). Conclusion: Patients with comorbid heart failure and airflow limitation were at more than double the risk for an event. Spirometric measures may be useful to patients with heart failure, as tailored management of airflow limitation may impact event-free survival.

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Daily Symptom Variability in Patients With Stable COPD: A Narrative Review

Cited by 6 publications

References 41 publications

<p>A Cross-Sectional Study in Patients with Severe COPD to Assess the Perception of Symptom Variability (COPVAR) in the Middle East and Africa</p>

<p>A Cross-Sectional Study in Patients with Severe COPD to Assess the Perception of Symptom Variability (COPVAR) in the Middle East and Africa</p>

Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study

Airflow limitation more than doubles the risk for hospitalization/mortality in patients with heart failure

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