Abstract:Productive cough was common and increased the risk for exacerbations in both sexes, in both COPD and non-COPD. COPD-subjects with productive cough had the highest risk for exacerbations and a significantly higher risk for death also after adjustment for common risk factors.
“…Nighttime symptoms were associated with future exacerbations (HR 2.3; 95% CI 1.7, 3.0) Putcha et al COPD 2014 [58]Patient questionnaire (COPD symptoms) Mortality data (mortality)Cough and phlegm symptoms together were associated with an increased risk of mortality (HR 1.27; 95% CI 1.02, 1.59) Lindberg et al Respir Med. 2015 [57]Patient interview (COPD symptoms and exacerbations) Mortality data (mortality)Patients with a productive cough have an increased risk of exacerbations (OR 9.25; 95% CI 6.23, 13.75), and a significantly increased risk of mortality (HR 1.48; 95% CI 1.13, 1.94) Miravitlles et al COPD 2016 [25]Patient questionnaire (COPD symptoms) Hospital admissions data (follow-up exacerbations)Early-morning and daytime symptoms were associated with exacerbations during follow-up (both p < 0.01), however significance was not maintained when adjusted for potential confounding factors
6MWT 6-Min Walk Test, CAT COPD Assessment Test, CI confidence interval, COPD chronic obstructive pulmonary disease, EQ-5D EuroQol five dimensions questionnaire, HADS Hospital Anxiety and Depression Scale, HR hazard ratio, HRQoL health-related quality of life, mMRC modified Medical Research Council, OR odds ratio, PCP primary care physician, QoL quality of life, SGRQ St. George’s Respiratory Questionnaire, UCSD University of California San DiegoFig. 3The relationship between dyspnea, depression/anxiety, reduction in physical activity, impact on quality of life, and disease prognosis.…”
Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden.
“…Nighttime symptoms were associated with future exacerbations (HR 2.3; 95% CI 1.7, 3.0) Putcha et al COPD 2014 [58]Patient questionnaire (COPD symptoms) Mortality data (mortality)Cough and phlegm symptoms together were associated with an increased risk of mortality (HR 1.27; 95% CI 1.02, 1.59) Lindberg et al Respir Med. 2015 [57]Patient interview (COPD symptoms and exacerbations) Mortality data (mortality)Patients with a productive cough have an increased risk of exacerbations (OR 9.25; 95% CI 6.23, 13.75), and a significantly increased risk of mortality (HR 1.48; 95% CI 1.13, 1.94) Miravitlles et al COPD 2016 [25]Patient questionnaire (COPD symptoms) Hospital admissions data (follow-up exacerbations)Early-morning and daytime symptoms were associated with exacerbations during follow-up (both p < 0.01), however significance was not maintained when adjusted for potential confounding factors
6MWT 6-Min Walk Test, CAT COPD Assessment Test, CI confidence interval, COPD chronic obstructive pulmonary disease, EQ-5D EuroQol five dimensions questionnaire, HADS Hospital Anxiety and Depression Scale, HR hazard ratio, HRQoL health-related quality of life, mMRC modified Medical Research Council, OR odds ratio, PCP primary care physician, QoL quality of life, SGRQ St. George’s Respiratory Questionnaire, UCSD University of California San DiegoFig. 3The relationship between dyspnea, depression/anxiety, reduction in physical activity, impact on quality of life, and disease prognosis.…”
Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden.
“…Chronic bronchitis is common in COPD, with estimates varying between 14% and 74%; it is a common reason for prescribing NAC, and it is also a risk factor of death. 34 Therefore, there are reasons to believe that NAC, as a marker of chronic bronchitis only, is associated with increased mortality. Beta-blockers were associated with decreased mortality in the current study, independently of hypertension and heart diseases.…”
Background: Life expectancy is significantly shorter for patients with chronic obstructive pulmonary disease (COPD) than the general population. Concurrent diseases are known to infer an increased mortality risk in those with COPD, but the effects of pharmacological treatments on survival are less established. This study aimed to examine any associations between commonly used drugs, comorbidities and mortality in Swedish real-world primary care COPD patients. Methods: Patients with physician-diagnosed COPD from a large primary care population were observed retrospectively, utilizing primary care records and mandatory Swedish national registers. The time to all-cause death was assessed in a stepwise multiple Cox proportional hazards regression model including demography, socioeconomic factors, exacerbations, comorbidities and medication. Results: During the observation period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)) 5776 (32.5%) of 17,745 included COPD patients died. Heart failure (hazard ratio [HR]: 1.88, 95% confidence interval [CI]: 1.74-2.04), stroke (HR: 1.52, 95% CI: 1.40-1.64) and myocardial infarction (HR: 1.40, 95% CI: 1.24-1.58) were associated with an increased risk of death. Use of inhaled corticosteroids (ICS; HR: 0.79, 95% CI: 0.66-0.94), beta-blockers (HR: 0.86, 95% CI: 0.76-0.97) and acetylsalicylic acid (ASA; HR: 0.87, 95% CI: 0.77-0.98) was dose-dependently associated with a decreased risk of death, whereas use of long-acting muscarinic antagonists (LAMA; HR: 1.33, 95% CI: 1.14-1.55) and N-acetylcysteine (NAC; HR: 1.26, 95% CI: 1.08-1.48) were dose-dependently associated with an increased risk of death in COPD patients. Conclusion: This large, retrospective, observational study of Swedish real-world primary care COPD patients indicates that coexisting heart failure, stroke and myocardial infarction were the strongest predictors of death, underscoring the importance of timely recognition and treatment of comorbidities. A decreased risk of death associated with the use of ICS, betablockers and ASA, and an increased risk associated with the use of LAMA and NAC, was also found.
Plain Language SummaryPatients with chronic obstructive lung disease (COPD) die earlier than healthy people. Having certain other diseases (for instance heart disorders) at the same time as COPD is common and known to increase the risk of death. It is not certain whether medication can improve survival or not. There is a need for deeper knowledge of the connection between other diseases, drugs and COPD deaths.
“…It is therefore not surprising that frequent exacerbators with chronic bronchitis present with higher healthcare costs and are at an increased risk of death compared with other COPD phenotypes [21, 22]. However, identifying these patients has therapeutic implications, as exacerbators with chronic bronchitis may be particularly responsive to specific anti-inflammatory treatments, such as phosphodiesterase-4 inhibitors [23].…”
Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these patients in this region.Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment.3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma–COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma–COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes.The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes.
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