Introduction
Compliance with Ethics Guidelines
Daily Symptom Burden of COPD
Study | Patient numbers | Type of questionnaire | Geographic region | Main measures | Main outcomes |
---|---|---|---|---|---|
24-h COPD symptoms and patient-reported outcomes: the ASSESS study Miravitlles et al. [7] | 727 | Baseline visit (Day 1) and a follow-up telephone interview after 6 months 33 items | Europe | Nighttime, early-morning, and daytime symptom questionnaire; FEV1; mMRC; CAT; HADS; CASIS; and physical activity level | In each part of the 24-h day, >60% of patients reported experiencing ≥1 symptom in the week before baseline Symptom prevalence: 81.4% in the early morning, 82.7% in the daytime, and 63.0% at night |
Symptom variability in patients with severe COPD in Europe Kessler et al. [6] | 2441 | Telephone questionnaire (20- to 30-min call) (NCT00722267) | Europe | Patient interview with questionnaire: symptoms and variability over the day, week, and year; sleep quality, tiredness, depression and anxiety; impact of symptoms on morning and other daily activities and the requirement for help to perform these activities | Breathlessness was the most common symptom (72.5%) Daily and/or weekly symptom variability was reported by 62.7% of symptomatic patients; the morning was the worst time of day |
Impact of COPD in the morning Partridge et al. [8] | 803 | Internet interviews 34 questions | Europe and USA | Questions pertaining to the nature, extent, and impact of COPD symptoms at different times of day and night | 46% of patients with severe COPD reported symptoms worst in the morning Shortness of breath was the most frequently reported symptom Walking up and down stairs, putting on socks and shoes, making the bed, dressing, washing, and drying were activities most affected by COPD |
Nighttime symptoms in COPD: a European study Price et al. [75] | 2807 | Patient and physician record form | Europe | Patients completed questionnaires on the time of day when their COPD symptoms bothered them, and the impact of COPD on their ability to get up in the morning and on sleep | Around 78% of patients reported nighttime disturbance Patients with nighttime symptoms experienced more daytime breathlessness and exacerbations in the previous 12 months, and received more maintenance therapy than those without Frequency of physician-reported and patient-reported nighttime symptom concordance was good Physicians significantly underestimated the impact of COPD on the patient’s ability to get up in the morning and on sleep |
Nighttime and early-morning symptoms of COPD Stephenson et al. [12] | 1239 | Telephone 30-min survey | USA | Specific symptoms experienced at night or in the early morning; number of nights/mornings during the past week that they had symptoms; severity of symptoms; impact of symptoms on sleep or early-morning activities; how long they had experienced their symptoms | 61.2% of patients reported nighttime and early-morning symptoms on at least three nights and three mornings during the week prior to the survey Patients with COPD with both or either nighttime/early-morning symptoms were associated with poorer health status compared to those without |
Morning symptoms in a real-world population with COPD Roche et al. [13] | 1489 | Adelphi Respiratory Disease Specific Programme (physician-reported ‘Patient record form’ and patient-reported ‘Patient self-completion form’) | Europe and USA | Symptoms over the previous 4 weeks and their impact on daily life Physician reported details of symptoms Patients reported (seven-point Likert scale) impact of symptoms | 39.8% of patients experienced morning symptoms Morning symptoms associated with higher CAT scores, higher exacerbation frequency, more frequent worsening of symptoms without consulting a health care professional, and increased impact on normal daily activities Morning symptoms had a greater impact on getting up and ready for the day and resulted in more days off work per year, in the working population |
The impact of morning symptoms on daily activities in COPD O’Hagan et al. [76] | 881 | A structured questionnaire completed online by patients 31 questions (17 main, 14 subordinate) | Europe, Brazil, Canada, China, and Japan | Diagnosis of COPD; co-morbidities; current treatment and goals of treatment; symptoms that were worse in the morning; the effect of symptoms on daily activities in the morning and the rest of the day | Patients reported activities took 10–30 min longer than before symptoms became worse in the morning Around half made changes to their morning routines and 54% reported morning symptoms affecting the rest of their day Over three-quarters believed their medications provided sufficient relief of morning symptoms but only 21% believed medication helped improve their ability to perform tasks |
Nighttime dyspnea prevalence in COPD and its implications Lange et al. [18] | 6616 | An extensive questionnaire (filled out by patient) | Europe | Lifestyle and health topics, including medication use at home GOLD1–4, FEV1, GOLDA–D, mMRC, and exacerbation frequency | Overall nighttime dyspnea prevalence: 4.3% Nighttime dyspnea by GOLD group: 2.1% GOLD A, 12.9% in GOLD B, 2.6% in GOLD C, 16.3% in GOLD D Individuals with nighttime dyspnea had lower FEV1, higher daytime mMRC scores, more wheezing, more often had chronic mucus hypersecretion, and more often reported stress, nervousness, and tiredness, than individuals without nighttime dyspnea |