Symptom variability in COPD: a narrative review

Lόpez-Campos, José Luís; Calero, Carmen; Quintana‐Gallego, Esther

doi:10.2147/copd.s42866

Cited by 53 publications

(62 citation statements)

References 44 publications

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“…Several studies have in fact demonstrated that the extent and perception of COPD symptoms are not as stable as previously believed, but show a variability that is not only seasonal, but also weekly and even daily, with symptoms often worsening at night and in the early morning [3, 4]. …”

Section: Main Textmentioning

confidence: 99%

“…An example of such “patient-centered” outcomes is given by the circadian variability of COPD symptoms, which has been shown to adversely affect the performance of normal daily activities and to have a substantial negative impact on the quality of life [4]. …”

Section: Main Textmentioning

confidence: 99%

“…The implementation of appropriate strategies for the optimal control of symptoms is also recommended, with particular regard to the time of maximum symptom intensity (e.g., nighttime, early morning) [4]. …”

Section: Main Textmentioning

confidence: 99%

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Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients?

2017

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BackgroundAs emphasized by international recommendations and largely confirmed by clinical experience, long-acting bronchodilators play a central role in the maintenance treatment of chronic obstructive pulmonary disease (COPD) due to their proven efficacy in reducing airflow obstruction and improving symptoms.Main bodyThere are some important aspects to define with regard to inhalation therapy for COPD, particularly those concerning the selection criteria and the optimal use of long-acting bronchodilators. First of all, it needs to be determined in which patients and clinical situations monotherapy with one bronchodilator, such as a long-acting muscarinic antagonist (LAMA), should be considered adequate, and in which cases the use of combination therapies, such as the “double bronchodilation” with a LAMA and a long-acting β2-agonist (LABA), should be preferred. Another critical issue concerns the effect of the frequency of daily administration of inhaled agents on the control of symptoms during the 24 h. COPD symptoms are known to exhibit considerable circadian variability with worsening in the early morning, and a significant proportion of patients have disease-related sleep disorders which can adversely affect their quality of life. The worsening of symptoms in the early morning may be due, at least in part, to a reduction in airway caliber caused by an increased “cholinergic tone” at night. As such, the coverage of nighttime and early morning symptoms is a reasonable therapeutic goal, which can be achieved by many patients using LAMAs such as aclidinium bromide twice daily (BID). Therapeutic adherence is known to be a multifactorial phenomenon that is frequently affected by other aspects than dosing frequency, including the technical features and ease of use of the inhalers. To this end, it should be mentioned that certain new-generation inhalers such as Genuair® have been associated in clinical trials with higher patient preference.ConclusionIn this work, in addition to presenting an overview of the main evidence on the efficacy of COPD treatment with the LAMA aclidinium bromide BID, we suggest some selection criteria for the monotherapy with one long-acting bronchodilator or the combination therapy with LAMA and LABA in COPD patients, with particular reference to specific clinical scenarios.

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Section: Main Textmentioning

confidence: 99%

Section: Main Textmentioning

confidence: 99%

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Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients?

2017

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“…However, this traditional paradigm has been contested in recent decades. Several studies have reported that COPDrelated symptoms are not uniformly perceived by patients in a similar manner, showing not just seasonal variation, but also changes in symptom perception over a week or even during a single day (3)(4)(5)(6)(7)(8)(9). This time-dependent variation is of substantial importance, since it has an impact on everyday life activities and health-related quality of life (HRQoL) (5).…”

Section: Introductionmentioning

confidence: 99%

Perception of circadian variation of symptoms in Chinese patients with chronic obstructive pulmonary disease

Wang

Cai

et al. 2017

J. Thorac. Dis.

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Background: Although, the variable pattern of asthmatic symptoms is well recognized, little is known about the respiratory symptoms variability in patients of chronic obstructive pulmonary disease (COPD). The present study evaluated the variability of the respiratory symptoms in a day and their influence on the daily activities in a cohort of Chinese COPD patients. Methods: An observational cross-sectional study was conducted in 11 medical centers of China.Participants were outpatient ≥40 years old with stable COPD, post-bronchodilator forced expiratory volume in 1 second (FEV1) <80% predicted. Overall, data of 1,032 eligible patients were valid for final analysis.Results: Mean post bronchodilator FEV1 (predicted %) was 46.5%. Cough, expectoration and dyspnea were the most commonly observed symptoms (73.6%, 68.8% and 61.4%, respectively). Daily symptom variability was experienced by 50.2% of symptomatic patients. The wake up time in the morning was the worst and the most troublesome time during the day (39.3%), followed by the nighttime (21.3%). The morning activities were most affected by COPD symptoms. Multivariate analyses revealed that COPD assessment test (CAT) scores was the only factor correlated with patients' symptom variability [odds ratio (OR) =0.463, P<0.0001]. Conclusions: Patient-perceived symptoms vary during the day in Chinese COPD patients. They experience the greatest increase in respiratory symptoms early in the morning. This variation should be considered as a potential new target in the long-term COPD management.

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“…In addition, recent studies suggest that the perception of symptoms may not be as stable as previously suggested. COPD-related symptoms are not consistently perceived by patients in the same way; changes in symptom perception have been observed over the course of a week or even within a single day (5,6), and several approaches have been developed to detect, measure, and manage the variations in the perception of symptoms among COPD patients (7,8).…”

Section: Introductionmentioning

confidence: 99%

Moving Towards Patient-Centered Medicine for COPD Management: Multidimensional ApproachesversusPhenotype-Based Medicine—A Critical View

Lόpez-Campos

Bustamante

Muñoz³

et al. 2014

COPD: Journal of Chronic Obstructive Pulmonary Disease

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For decades, chronic obstructive pulmonary disease (COPD) has been considered a relentlessly progressive disease in which the deterioration of lung function is associated with an increase in symptoms, interrupted only by periods of exacerbation. However, this paradigm of COPD severity based on FEV1 has been challenged by currently available evidence. So far, three main approaches, though with contradictory aspects, have been proposed in order to address the complexity of COPD as well as to develop appropriate diagnostic, prognostic and therapeutic strategies for the disease: 1) the use of independent, clinically relevant variables, 2) the use of multidimensional indices, and 3) disease approaches based on clinical phenotypes. Multivariable systems seem superior to FEV1 in predicting prognosis and defining disease severity. However, selection of variables available from current literature must be confronted with issues of medical practice. Future evidence will be needed to reveal their effective relationship with disease long-term prognosis and to demonstrate the most adequate cutoff values to be used in clinical settings. Multidimensional scores provide a good prognostic instrument for the identification of patients with a particular degree of disease severity. Clinical phenotyping can help clinicians identify the patients who respond to specific pharmacological interventions; however, there is some controversy about the phenotypes to select and their long-term implications. Although these approaches are not perfect, they represent the first step towards patient-centered medicine for COPD. In the near-future, these different approaches should converge towards one new field to focus on the better management of COPD patients.

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Symptom variability in COPD: a narrative review

Cited by 53 publications

References 44 publications

Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients?

Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients?

Perception of circadian variation of symptoms in Chinese patients with chronic obstructive pulmonary disease

Moving Towards Patient-Centered Medicine for COPD Management: Multidimensional ApproachesversusPhenotype-Based Medicine—A Critical View

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