Patient's Perception of Symptoms Related to Morning Activity in Chronic Obstructive Pulmonary Disease: The SYMBOL Study

Kim, Yeon Jae; Lee, Byung Ki; Jung, Chi Young; Jeon, Young June; Hyun, Dae Sung; Kim, Kyung Chan; Yu, Sung Ken; Choi, Hye Sook; Shin, Won Hyuk; Lee, Kwan Ho

doi:10.3904/kjim.2012.27.4.426

Cited by 34 publications

(63 citation statements)

References 34 publications

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“…Other real-life studies have reported lower prevalence of morning symptoms, i.e. 57% of 133 patients or 40% of 1489 patients with COPD, respectively [24,25]. A possible explanation for the high proportion of patients with early-morning symptoms in our study may be the fact that 31% of the study population were newly diagnosed with COPD and untreated at study start; thus, COPD-related symptoms, if probably only of mild intensity, may have been more frequent among these patients than among already treated patients.…”

Section: Discussionmentioning

confidence: 95%

Improvements in patient-reported outcomes: A prospective, non-interventional study with aclidinium bromide for treatment of COPD

Marth

Schüller²,

Pohl

2015

Respiratory Medicine

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Section: Discussionmentioning

confidence: 95%

Improvements in patient-reported outcomes: A prospective, non-interventional study with aclidinium bromide for treatment of COPD

Marth

Schüller²,

Pohl

2015

Respiratory Medicine

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“…Finally, in a recent Korean study, Kim et al prospectively recorded data on the symptom perception of 133 COPD patients with severe airflow limitation 15. The authors found that 57% of patient-reported morning symptoms.…”

Section: Symptom Variability Exists In Copdmentioning

confidence: 99%

Symptom variability in COPD: a narrative review

Lόpez-Campos¹,

Calero²,

Quintana‐Gallego³

2013

COPD

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Chronic obstructive pulmonary disease (COPD) has traditionally been considered an inexorably progressive disease, associated with a constant increase of symptoms that occur as the forced expiratory volume in 1 second (FEV1) worsens, only intermittently interrupted by exacerbations. However, this paradigm has been challenged in recent decades by the available evidence. Recent studies have pointed out that COPD-related symptoms are not consistently perceived by patients in the same way, showing not only seasonal variation, but also changes in symptom perception during a week or even within a single day. According to the available data, patients experience the biggest increase in respiratory symptoms during the first hours of the early morning, followed by the nighttime. This variation over time is of considerable importance, since it impacts on daily life activities and health-related quality of life, as measured by a recently developed ad hoc questionnaire. Additionally, recent clinical trials have suggested that the use of rapid-onset long-acting bronchodilators may have an impact on morning symptoms, despite their current use as maintenance treatment for a determined period. Although this hypothesis is to be validated in future long-term clinical trials comparing fast-onset versus slow-onset inhaled drugs in COPD, it may bring forward a new concept of long-term bronchodilator therapy. At the present time, the two available long-acting, fast-onset bronchodilators used in the treatment of COPD are formoterol and the recently marketed indacaterol. Newer drugs have also been shown to have a rapid onset of action in preclinical studies. Health care professionals caring for COPD patients should consider this variation in the perception of symptoms during their clinical interview as a potential new target in the long-term treatment plan.

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“…However, the prevalence of morning symptoms seems to be heavily dependent on the used questionnaire 5. In addition, few studies assessed the severity of morning symptoms in relation to COPD severity and identified factors that are associated with morning symptoms 2,6,7…”

Section: Introductionmentioning

confidence: 99%

The association between objectively measured physical activity and morning symptoms in COPD

Buul¹,

Kasteleyn

Chavannes

et al. 2017

COPD

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PurposeThe morning is the most bothersome period for COPD patients. Morning symptom severities in different Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages are not well studied. Furthermore, factors that are associated with morning symptoms, especially the associations with objectively measured physical activity, are also not well described.Materials and methodsThe aim of this cross-sectional observational study was to assess morning symptom severity in GOLD A, B, C and D patients, according to the definitions of the GOLD 2015 statement. Morning symptoms were assessed with the PRO-Morning COPD Symptoms Questionnaire. Differences in morning symptom severity between different COPD stages were assessed with a one-way analysis of variance followed by post hoc analyses. The association between dyspnea severity (assessed with the modified Medical Research Council scale), health status, airflow limitation, lung hyperinflation, anxiety and depression, inflammatory parameters, exacerbations, objectively measured physical activity parameters retrieved from accelerometry and morning symptom severity was evaluated using linear regression analysis.ResultsEighty patients were included (aged 65.6±8.7 years, forced expiratory volume in 1 second [FEV1] % predicted 55.1±16.9). Mean (±SD) morning symptom score was 19.7 (±11.7). Morning symptom severity was significantly different between COPD stages: mean (±SD) score in GOLD A was 9.7 (±7.2), in GOLD B 19.8 (±10.7), in GOLD C 8.6 (±9.3) and in GOLD D 23.8 (±11.2) (p<0.001). Lower health status, more symptoms, increased anxiety and depression, less physical activity (all p<0.001) and lower FEV1 (p=0.03) were associated with an increased morning symptom severity.ConclusionPatients with overall more symptomatic COPD have significant higher morning symptom scores. Morning symptom severity was associated with important clinical outcomes: lower health status, more symptoms, increased anxiety and depression, fewer steps a day, less time in moderate and vigorous physical activity with bouts of at least 10 minutes and lower FEV1. The data suggest that morning symptoms should be carefully assessed in addition to assessment by general COPD-specific questionnaires, especially in those with more symptomatic COPD. More research is needed on potential therapies to improve morning symptoms; this study shows potential targets for intervention.

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Patient's Perception of Symptoms Related to Morning Activity in Chronic Obstructive Pulmonary Disease: The SYMBOL Study

Cited by 34 publications

References 34 publications

Improvements in patient-reported outcomes: A prospective, non-interventional study with aclidinium bromide for treatment of COPD

Improvements in patient-reported outcomes: A prospective, non-interventional study with aclidinium bromide for treatment of COPD

Symptom variability in COPD: a narrative review

The association between objectively measured physical activity and morning symptoms in COPD

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