High 24-Hour Respiratory Symptoms and Low Physical Activity in the Stable COPD Romanian Cohort of SPACE Study

Florin Mihaltan, Ruxandra-Mioara Rajnoveanu, Oana Cristina Arghir, Silviu Alecu, Paraschiva A Postolache, Florin Mihaltan, Ruxandra-Mioara Rajnoveanu, Oana Cristina Arghir, Silviu Alecu, Paraschiva A Postolache

Abstract

Objective: This study assessed the characteristics and the relationship between symptoms in any part of the 24-hour (24-h) day, physical activity level (PAL), and other clinical and functional outcomes in stable COPD patients.

Patients and methods: Out of the 2162 patients enrolled in the SPACE study (The Symptoms and Physical Activity in COPD patients in Europe, clinicaltrials.gov NCT03031769), 406 (18.8%) were recruited from Romania. Here, we present the Romanian cohort results. Eligible patients were adults with age at least 40 years, confirmed diagnosis of stable COPD, current or former smokers with a smoking history of minimum 10 pack-years. The 24-h respiratory symptoms were assessed using Early Morning Symptoms of COPD Instrument (EMSCI), Evaluating Respiratory Symptoms in COPD (E-RS™: COPD) and Nighttime Symptoms of COPD Instrument (NiSCI). During clinical interview, patients self-evaluated PAL through Exercise as Vital Sign (EVS) and Yale Physical Activity Survey (YPAS). Physicians assessed PAL through their clinical judgment.

Results: For each combination of 2 between the early morning (EM), daytime (DT) and night-time (NT) symptoms of the 24-h day, there was a significant association (p < 0.001 for each). All symptoms significantly correlated with exacerbation history (p < 0.001 for EM and NT, p=0.002 for DT), and number of severe exacerbations (p < 0.001 for DT, p=0.001 for EM and p=0.026 for NT, respectively). The 24-h symptoms correlated negatively and significantly with PAL (p < 0.001), irrespective of the assessment used. Self-reported PAL negatively correlated with dyspnea, symptom burden, severity of disease and number of exacerbations (p < 0.001). Patients spent an average (standard deviation) of 25.8 (21.0) hours/week performing physical activity. Physicians overestimated their patients' daily PAL.

Conclusion: A negative and significant correlation between the 24-h day symptoms and PAL was identified in stable COPD patients. Physicians need to routinely assess PAL using adequate tools and start educating inactive COPD patients to optimize their disease outcomes.

Keywords: COPD; physical activity; respiratory symptoms.

Conflict of interest statement

SA is employee of AstraZeneca. All the other authors have no competing interests to declare in regard to this study.

© 2021 Mihaltan et al.

Figures

Figure 1
Figure 1
Distribution of patients in ABCD groups using the 2013 (A) and 2017 (B) GOLD edition.
Figure 2
Figure 2
Prevalence of individual respiratory symptoms assessed by questionnaires corresponding for each part of the 24-h day EMSCI, NiSCI and E-RS™:COPD.
Figure 3
Figure 3
The physical activity level assessed by Investigators (clinical judgment) and self-assessed by patients (EVS questions).
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8433128/bin/COPD-16-2533-g0001.jpg

References

    1. Global Initiative for Chronic Obstructive Lung Disease. Global initiative for the diagnosis, prevention and management of chronic obstructive pulmonary disease, report 2021. Available from: . Accessed April26, 2021.
    1. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–365. doi:10.1164/rccm.201204-0596PP
    1. Global Initiative for Chronic Obstructive Lung Disease. Global initiative for the diagnosis, prevention and management of chronic obstructive pulmonary disease, report 2017. Available from: . Accessed November3, 2020.
    1. Partridge MR, Karlsson N, Small IR. Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey. [published correction appears in Curr Med Res Opin. 2012;28(8):1405]. Curr Med Res Opin. 2009;25(8):2043–2048. doi:10.1185/03007990903103006
    1. Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: a pan-European Cross-Sectional Study. Eur Respir J. 2011;37(2):264–272. doi:10.1183/09031936.00051110
    1. Jenkins CR, Celli B, Anderson JA, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH Study. Eur Respir J. 2012;39(1):38–45. doi:10.1183/09031936.00194610
    1. Miravitlles M, Worth H, Soler Cataluña JJ, et al. Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS Study. Respir Res. 2014;15(1):122. doi:10.1186/s12931-014-0122-1
    1. Miravitlles M, Izquierdo JL, Esquinas C, et al. The variability of respiratory symptoms and associated factors in COPD. Respir Med. 2017;129:165–-172. doi:10.1016/j.rmed.2017.06.017
    1. Roche N, Chavannes NH, Miravitlles M. COPD symptoms in the morning: impact, evaluation and management. Respir Res. 2013;14(1):112. doi:10.1186/1465-9921-14-112
    1. Tsiligianni I, Metting E, van der Molen T, Chavannes N, Kocks J. Morning and night symptoms in primary care COPD patients: a cross-sectional and longitudinal study. An UNLOCK study from the IPCRG. NPJ Prim Care Respir Med. 2016;26(1):16040. doi:10.1038/npjpcrm.2016.40
    1. van Buul AR, Kasteleyn MJ, Chavannes NH, Taube C. Association between morning symptoms and physical activity in COPD: a systematic review. Eur Respir Rev. 2017;26(143):160033. doi:10.1183/16000617.0033-2016
    1. Kapella MC, Larson JL, Covey MK, Alex CG. Functional performance in chronic obstructive pulmonary disease declines with time. Med Sci Sports Exerc. 2011;43(2):218–224. doi:10.1249/MSS.0b013e3181eb6024
    1. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Antó JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a Population Based Cohort Study. Thorax. 2006;61(9):772–778. doi:10.1136/thx.2006.060145
    1. Gimeno-Santos E, Frei A, Steurer-Stey C, et al. Determinants and outcomes of physical activity in patients with COPD: a systematic review. Thorax. 2014;69(8):731–739. doi:10.1136/thoraxjnl-2013-204763
    1. ZuWallack R, Esteban C. Understanding the impact of physical activity in COPD outcomes: moving forward. Eur Respir J. 2014;44(5):1107–1109. doi:10.1183/09031936.00151014
    1. Mihaltan FD, Nedelcu RE, Ionescu A, Nemes R. Romanian awareness campaign on the WORLD COPD day. Eur Respir J. 2015;46(suppl59):PA1060. doi:10.1183/13993003.congress-2015.PA1060
    1. Nedelcu RE, Mihaltan FD, Ulmeanu R. Romanian awareness and screenings for obstructive airway disease - world asthma and COPD day 2017. Eur Res J. 2018;52(suppl62):PA4420. doi:10.1183/13993003.congress-2018.PA4420
    1. Tudorache V, Oancea C, Avram C, Fira-Mlădinescu O. Changes in physical activity in healthy people and COPD patients. Wien Klin Wochenschr. 2014;126(1–2):30–35. doi:10.1007/s00508-013-0452-x
    1. Bertici N, Fira-Mlădinescu O, Oancea C, Tudorache V. The usefulness of pedometry in patients with chronic obstructive pulmonary disease. Multidiscip Respir Med. 2013;8(1):7. doi:10.1186/2049-6958-8-7
    1. Mihălţan F, Ungureanu D. Correlation between patient perception of the ability to perform morning activities and findings on clinical examination in COPD patients in Romania. Pneumologia. 2016;65(3):138–141.
    1. Troosters T, Bourbeau J, Maltais F, et al. Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO Randomised, Placebo-Controlled Study design. BMJ Open. 2016;6(4):e010106. doi:10.1136/bmjopen-2015-010106
    1. Kantorowksi A, Wan ES, Homsy D, Kadri R, Richardson CR, Moy ML. Determinants and outcomes of change in physical activity in COPD. ERJ Open Res. 2018;4(3):00054–2018. doi:10.1183/23120541.00054-2018
    1. Watz H, Pitta F, Rochester CL, et al. An official European respiratory society statement on physical activity in COPD. Eur Respir J. 2014;44(6):1521–1537. doi:10.1183/09031936.00046814
    1. Watz H, Waschki B, Meyer T, Magnussen H. Physical activity in patients with COPD. [published correction appears in Eur Respir J. 2010;36(2):462]. Eur Respir J. 2009;33(2):262–272. doi:10.1183/09031936.00024608
    1. Mihaltan F, Adir Y, Antczak A, et al. Importance of the relationship between symptoms and self-reported physical activity level in stable COPD based on the results from the SPACE study. Respir Res. 2019;20(1):89. doi:10.1186/s12931-019-1053-7
    1. Divo M, Cote C, de Torres JP, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;186(2):155–161. doi:10.1164/rccm.201201-0034OC
    1. Soler-Cataluna JJ, Martínez-García MA, Sánchez LS, et al. Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. Respir Med. 2009;103(5):692–699. doi:10.1016/j.rmed.2008.12.005
    1. Lee H, Kim J, Tagmazyan K. Treatment of stable chronic obstructive pulmonary disease: the GOLD guidelines. Am Fam Physician. 2013;88(10):655–63, 663B-F.
    1. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–586. doi:10.1136/thx.54.7.581
    1. Jones JW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD assessment test. Eur Respir J. 2009;34(3):648–654. doi:10.1183/09031936.00102509
    1. Stephenson JJ, Cai Q, Mocarski M, Tan H, Doshi JA, Sullivan SD. Impact and factors associated with nighttime and early morning symptoms among patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10:577–586. doi:10.2147/COPD.S76157
    1. Leidy NK, Sexton CC, Jones PW, et al. Measuring respiratory symptoms in clinical trials of COPD: reliability and validity of a daily diary. Thorax. 2014;69(5):443–449. doi:10.1136/thoraxjnl-2013-204428
    1. Mocarski M, Zaiser E, Trundell D, Make BJ, Hareendran A. Evaluation of the psychometric properties of the nighttime symptoms of COPD instrument. Int J Chron Obstruct Pulmon Dis. 2015;10:475–487. doi:10.2147/COPD.S75776
    1. Coleman KJ, Ngor E, Reynolds K, et al. Initial validation of an exercise “vital sign” in electronic medical records. Med Sci Sports Exerc. 2012;44(11):2071–2076. doi:10.1249/MSS.0b013e3182630ec1
    1. Grant RW, Schmittdiel JA, Neugebauer RS, Uratsu CS, Sternfeld B. Exercise as a vital sign: a quasi-experimental analysis of a health system intervention to collect patient-reported exercise levels. J Gen Intern Med. 2014;29(2):341–348. doi:10.1007/s11606-013-2693-9
    1. Dipietro L, Caspersen CJ, Ostfeld AM, Nadel ER. A survey for assessing physical activity among older adults. Med Sci Sports Exerc. 1993;25(5):628–642. doi:10.1249/00005768-199305000-00016
    1. Di Marco F, Santus P, Scichilone N, et al. Symptom variability and control in COPD: advantages of dual bronchodilation therapy. Respir Med. 2017;125:49–56. doi:10.1016/j.rmed.2017.03.001
    1. O’Donnell DE. Hyperinflation, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2006;3(2):180–184. doi:10.1513/pats.200508-093DO
    1. Albarrati AM, Gale NS, Munnery MM, Cockcroft JR, Shale DJ. Daily physical activity and related risk factors in COPD. BMC Pulm Med. 2020;20(1):60. doi:10.1186/s12890-020-1097-y
    1. Sánchez-Martínez MP, Bernabeu-Mora R, García-Vidal JA, et al. Patterns and predictors of low physical activity in patients with stable COPD: a Longitudinal Study. Ther Adv Respir Dis. 2020;14:1753466620909772. doi:10.1177/1753466620909772
    1. Mantoani LC, Rubio N, McKinstry B, MacNee W, Rabinovich RA. Interventions to modify physical activity in patients with COPD: a systematic review. Eur Respir J. 2016;48(1):69–81. doi:10.1183/13993003.01744-2015
    1. Cook N, Gey J, Oezel B, et al. Impact of cough and mucus on COPD patients: primary insights from an exploratory study with an online patient community. Int J Chron Obstruct Pulmon Dis. 2019;14:1365–1376. doi:10.2147/COPD.S202580
    1. López-López L, Torres-Sánchez I, Romero-Fernández R, Granados-Santiago M, Rodríguez-Torres J, Valenza MC. Impact of previous physical activity levels on symptomatology, functionality, and strength during an acute exacerbation in COPD patients. Healthcare (Basel). 2018;6(4):139. doi:10.3390/healthcare6040139
    1. De Abajo S, Larriba R, Marquez S. Validity and reliability of the Yale physical activity survey in Spanish elderly. J Sports Med Phys Fitness. 2001;41(4):479–485.
    1. Donaire-Gonzales D, Gimeno-Santos E, Serra I, et al. Validación del cuestionario de actividad física de Yale en pacientes con enfermedad pulmonar obstructiva crónica [validation of the Yale physical activity survey in chronic obstructive pulmonary disease patients]. Arch Bronconeumol. 2011;47(11):552–560. doi:10.1016/j.arbres.2011.07.002
    1. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998–1005. doi:10.1249/MSS.0b013e3181930355
    1. Lewthwaite H, Effing TW, Olds T, Williams MT. Physical activity, sedentary behaviour and sleep in COPD guidelines: a systematic review. Chron Respir Dis. 2017;14(3):231–244. doi:10.1177/1479972316687224
    1. Hartman JE, Boezen HM, de Greef MH, Ten Hacken NH. Physical and psychosocial factors associated with physical activity in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2013;94(12):2396–2402.e7. doi:10.1016/j.apmr.2013.06.029
    1. Lewthwaite H, Effing TW, Lenferink A, Olds T, Williams MT. Improving physical activity, sedentary behaviour and sleep in COPD: perspectives of people with COPD and experts via a Delphi approach. PeerJ. 2018;6:e4604. doi:10.7717/peerj.4604
    1. Burge AT, Cox NS, Abramson MJ, Holland AE. Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2020;4(4):CD012626. doi:10.1002/14651858.CD012626.pub2
    1. Araújo A. COPD and physical activity. Rev Port Pneumol. 2016;22(5):299–301. doi:10.1016/j.rppnen.2016.02.009
    1. Lahham A, Burge AT, McDonald CF, Holland AE. How do healthcare professionals perceive physical activity prescription for community-dwelling people with COPD in Australia? A Qualitative Study. BMJ Open. 2020;10(8):e035524. doi:10.1136/bmjopen-2019-035524
    1. Postolache P, Pop CS, Nemes RM, Nitu FM. Pulmonary rehabilitation in COPD. Arch Balk Med Union. 2015;50(2):262–267.
    1. Royal College of Physicians. National Asthma and COPD Audit Programme (NACAP) [homepage on the Internet]. United Kingdom: National Asthma and COPD Audit Programme (NACAP): pulmonary rehabilitation workstream; 2020. Available from: . Accessed July26, 2021.
    1. Faculty of Sport and Exercise Medicine UK. Moving Medicine [homepage on the Internet]. United Kingdom: Consultation Guides - COPD; 2021. Available from: . Accessed July26, 2021.
    1. Hall G, Laddu DR, Phillips SA, Lavie CJ, Arena R. A tale of two pandemics: how will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another? Prog Cardiovasc Dis. 2020;2021(64):108–110. doi:10.1016/j.pcad.2020.04.005
    1. Karloh M, Sousa Matias T, Fleig Mayer A. The COVID-19 pandemic confronts the motivation fallacy within pulmonary rehabilitation programs. COPD. 2020;17(4):343–345. doi:10.1080/15412555.2020.1790511
    1. Cox NS, Dal Corso S, Hansen H, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev. 2021;1(1):CD013040. doi:10.1002/14651858.CD013040.pub2
    1. Balteanu M, Kamal C, Kamal D, Postolache P, Traistaru R. Pulmonary rehabilitation in COPD patients. Med Surg J. 2018;122(3):474–483.
    1. Thyregod M, Bodtger U. Coherence between self-reported and objectively measured physical activity in patients with chronic obstructive lung disease: a systematic review. Int J Chron Obstruct Pulmon Dis. 2016;11:2931–2938. doi:10.2147/COPD.S116422

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