The variability of respiratory symptoms and associated factors in COPD

• Published in: Respiratory medicine 2017-08, Vol.129, p.165-172
• Main Authors: Miravitlles, Marc, Izquierdo, José Luis, Esquinas, Cristina, Pérez, Maite, Calle, Myriam, López-Campos, José Luis, Rodríguez González-Moro, José Miguel, Casanova, Ciro, Esteban, Cristóbal, de Lucas, Pilar
• Format: Article
• Language: English
• Subjects: Activities of Daily Living - psychology; Aged; Anxiety; Anxiety - complications; Asthma; Bronchitis; Chronic obstructive pulmonary disease; Circadian Rhythm - physiology; Comorbidity; COPD; Disease Progression; Dyspnea; Dyspnea - diagnosis; Dyspnea - drug therapy; Dyspnea - psychology; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Morning; Night; Patients; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Quality of Life; Questionnaires; Respiration; Severity of Illness Index; Sleep; Sleep Wake Disorders - complications; Spirometry - methods; Symptoms; Variability; Vital Capacity
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2017.06.017

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. •48% of patients reported night-time symptoms and 71% reported morning symptoms.•There is a high variability in number and intensity of symptoms over a week.•Dyspnea, exacerbations and asthma-COPD are associated with variability of symptoms.