The variability of respiratory symptoms and associated factors in COPD

Abstract

Few studies have investigated the variability of COPD-related symptoms or factors related to symptom variability. This observational, prospective, multicentre study was conducted to describe the number and intensity of morning and night-time respiratory symptoms and their variability over one week using the Night-time and Early Morning Symptoms of COPD Instruments (NiSCI and EMSCI) to evaluate stable COPD patients. Logistic regression analyses were performed to investigate factors associated with symptom variability. A total of 2669 patients were evaluated (mean age, 67.7 years; 80.9% men; mean FEV1 50.6%). Of these, 48% reported night-time symptoms and 71% reported morning symptoms. Of the 2293 patients who completed the NiSCI and EMSCI, 90% showed variability in either symptom number (89.6%) or symptom intensity (15.8%). More severe dyspnoea, more exacerbations during the previous year and the exacerbator or mixed COPD-asthma phenotypes were associated with variability in symptom number or intensity. Anxiety was significantly associated with variability in symptom number and intensity. Most COPD patients showed symptom variability over a weeklong period, especially in terms of symptom number. Several COPD-related factors, mainly factors related to more severe disease and more frequent exacerbations, were associated with increased symptom variability.

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study

“…Cough and sputum, followed by dyspnoea, were also the most frequent morning symptoms in a more recent international study, with 88% of patients reporting these symptoms being of mild or moderate severity [6]. The prevalence of morning symptoms in COPD ranges from 37% to 94% across different studies, depending on the severity of the patients studied and the definition used [4,27,28]. We used a very restrictive definition of "significant" morning symptoms that required at least moderate dyspnoea plus another moderate symptom.…”

Daytime symptoms of chronic obstructive pulmonary disease: a systematic review

“…,16,23,[28][29][30][32][33][34] For example, a prevalence of 81.4% for morning symptoms and 63.0% for night-time symptoms was reported by Miravitlles et al4 Similar trends of morning and/or daytime versus night-time symptom prevalence were reported by Bateman et al23 (94.4 versus 88.3%), Marth et al28 (91.7 versus 70.6%), Soler-Cataluna et al…”

“…Interestingly, in the two articles assessing the relationship between symptoms and a history of exacerbations (all based on large-scale, observational/ real-world datasets), the presence of morning or daytime COPD symptoms was strongly associated with a higher frequency of exacerbations in the preceding 12 months. 14,15 Another study by Miravitlles et al 33 found that any type of symptom variability was significantly associated with more exacerbations in the previous year.…”

“…Daytime COPD symptoms: prevalence, variability, and burden Information on the prevalence (number of patients reporting symptoms) of common daytime symptoms of COPD was collated from 18 articles that had extractable data ( Supplementary Table 4). 2,4,12,[14][15][16][23][24][25][26][27][28][29][30][31][32][33][34] In nine articles, the relative prevalence rates of COPD symptoms (both for all symptoms and for individual symptoms) were generally higher in the morning and/or daytime (when defined, this was usually the time between the morning period and when the patient goes to bed) compared with at night ( Supplementary Table 4). 4 33 (71 versus 48%).…”

“…4,29 In this review, four articles reported on the relationship between daytime COPD symptoms and exacerbations. [14][15][16]33 In one, describing data from a large, cross-sectional, observational study, Tsiligianni et al 16 noted no statistically significant association between morning COPD symptoms and the likelihood of exacerbations 10-17 months after the baseline visit; this was based on logistic regression models. Similarly, in another large observational study, Miravitlles et al 14 showed that the presence of early morning or daytime symptoms were not independent predictors of exacerbations during the 6 months following baseline in a logistic regression model.…”