Understanding the impact of symptoms on the burden of COPD

Marc Miravitlles, Anna Ribera, Marc Miravitlles, Anna Ribera

Abstract

Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden.

Keywords: Burden; Chronic obstructive pulmonary disease; Patient-reported outcomes; Symptoms; Variability.

Figures

Fig. 1
Fig. 1
a Time of day when COPD symptoms are worse than usual. Reproduced from [17]; b prevalence of any COPD symptoms during each part of the 24-h day, according to COPD severity. Reproduced from [3]. *p < 0.001 vs ‘midday’, ‘afternoon’, ‘evening’, ‘night’, and ‘difficult to say’ groups; p = 0.006 vs ‘no particular time of day’ (all COPD patients); †p < 0.001 vs ‘midday’. COPD chronic obstructive pulmonary disease
Fig. 2
Fig. 2
Cross-sectional associations (Pathways #1 and #2), longitudinal associations (Pathway #3), and cognitive deficits or psychological factors as potential mediators in longitudinal associations (Pathway #4) as described by Omachi et al. Reproduced from [52]. COPD chronic obstructive pulmonary disease
Fig. 3
Fig. 3
The relationship between dyspnea, depression/anxiety, reduction in physical activity, impact on quality of life, and disease prognosis. COPD chronic obstructive pulmonary disease; QoL, quality of life

References

    1. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27:397–412. doi: 10.1183/09031936.06.00025805.
    1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442. doi: 10.1371/journal.pmed.0030442.
    1. Miravitlles M, Worth H, Soler Cataluna JJ, Price D, De Benedetto F, Roche N, 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;15:122. doi: 10.1186/s12931-014-0122-1.
    1. Jones PW, Brusselle G, Dal Negro RW, Ferrer M, Kardos P, Levy ML, et al. Patient-centred assessment of COPD in primary care: experience from a cross-sectional study of health-related quality of life in Europe. Prim Care Respir J. 2012;21:329–336. doi: 10.4104/pcrj.2012.00065.
    1. Kessler R, Partridge MR, Miravitlles M, Cazzola M, Vogelmeier C, Leynaud D, et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J. 2011;37:264–272. doi: 10.1183/09031936.00051110.
    1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2017. []. Accessed 17 Nov 2016.
    1. van der Molen T, Miravitlles M, Kocks JW. COPD management: role of symptom assessment in routine clinical practice. Int J Chron Obstruct Pulmon Dis. 2013;8:461–471. doi: 10.2147/COPD.S49392.
    1. Kornmann O, Beeh KM, Beier J, Geis UP, Ksoll M, Buhl R. Newly diagnosed chronic obstructive pulmonary disease. Clinical features and distribution of the novel stages of the Global Initiative for Obstructive Lung Disease. Respiration. 2003;70:67–75.
    1. Kaplan A, Marciniuk D, Bouchard J, Tessier L. Patient symptoms dictate how physicians behave in the early diagnosis of COPD [abstract] Prim Care Respir J. 2011;20:A6. doi: 10.4104/pcrj.2011.00004.
    1. Lopez-Campos JL, Calero C, Quintana-Gallego E. Symptom variability in COPD: a narrative review. Int J Chron Obstruct Pulmon Dis. 2013;8:231–238. doi: 10.2147/COPD.S42866.
    1. Miravitlles M, Anzueto A, Legnani D, Forstmeier L, Fargel M. Patient’s perception of exacerbations of COPD--the PERCEIVE study. Respir Med. 2007;101:453–460. doi: 10.1016/j.rmed.2006.07.010.
    1. Monteagudo M, Rodríguez-Blanco T, Llagostera M, Valero C, Bayona X, Ferrer M, et al. Factors associated with changes in quality of life of COPD patients: a prospective study in primary care. Respir Med. 2013;107:1589–1597. doi: 10.1016/j.rmed.2013.05.009.
    1. Price D, Small M, Milligan G, Higgins V, Garcia Gil E, Estruch J. Impact of night-time symptoms in COPD: a real-world study in five European countries. Int J Chron Obstruct Pulmon Dis. 2013;8:595–603. doi: 10.2147/COPD.S48570.
    1. Roche N, Chavannes NH, Miravitlles M. COPD symptoms in the morning: impact, evaluation and management. Respir Res. 2013;14:112. doi: 10.1186/1465-9921-14-112.
    1. Tsiligianni I, Kocks J, Tzanakis N, Siafakas N, van der Molen T. Factors that influence disease-specific quality of life or health status in patients with COPD: a review and meta-analysis of Pearson correlations. Prim Care Respir J. 2011;20:257–268. doi: 10.4104/pcrj.2011.00029.
    1. Doyle T, Palmer S, Johnson J, Babyak MA, Smith P, Mabe S, et al. Association of anxiety and depression with pulmonary-specific symptoms in chronic obstructive pulmonary disease. Int J Psychiatry Med. 2013;45:189–202. doi: 10.2190/PM.45.2.g.
    1. Partridge MR, Karlsson N, Small IR. Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey. Curr Med Res Opin. 2009;25:2043–2048. doi: 10.1185/03007990903103006.
    1. Roche N, Small M, Broomfield S, Higgins V, Pollard R. Real world COPD: association of morning symptoms with clinical and patient reported outcomes. COPD. 2013;10:679–686. doi: 10.3109/15412555.2013.844784.
    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: doi:10.1183/16000617.0033-2016.
    1. Agusti A, Hedner J, Marin JM, Barbé F, Cazzola M, Rennard S. Night-time symptoms: a forgotten dimension of COPD. Eur Respir Rev. 2011;20:183–194. doi: 10.1183/09059180.00004311.
    1. Lange P, Marott JL, Vestbo J, Nordestgaard BG. Prevalence of night-time dyspnoea in COPD and its implications for prognosis. Eur Respir J. 2014;43:1590–1598. doi: 10.1183/09031936.00196713.
    1. Donaldson GC, Wedzicha JA. The causes and consequences of seasonal variation in COPD exacerbations. Int J Chron Obstruct Pulmon Dis. 2014;9:1101–1110. doi: 10.2147/COPD.S54475.
    1. Jenkins CR, Celli B, Anderson JA, Ferguson GT, Jones PW, Vestbo J, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur Respir J. 2012;39:38–45. doi: 10.1183/09031936.00194610.
    1. Espinosa de los Monteros MJ, Peña C, Soto Hurtado EJ, Jareño J, Miravitlles M. Variability of respiratory symptoms in severe COPD. Arch Bronconeumol. 2012;48:3–7. doi: 10.1016/j.arbres.2011.07.004.
    1. Miravitlles M, Worth H, Soler-Cataluna JJ, Price D, De Benedetto F, Roche N, et al. The relationship between 24-hour symptoms and COPD exacerbations and healthcare resource use: results from an observational study (ASSESS). COPD. 2016;13:561–8.
    1. Kim YJ, Lee BK, Jung CY, Jeon YJ, Hyun DS, Kim KC, et al. Patient’s perception of symptoms related to morning activity in chronic obstructive pulmonary disease: the SYMBOL study. Korean J Intern Med. 2012;27:426–435. doi: 10.3904/kjim.2012.27.4.426.
    1. Stephenson JS, 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. O’Hagan P, Chavannes NH. The impact of morning symptoms on daily activities in chronic obstructive pulmonary disease. Curr Med Res Opin. 2014;30:301–314. doi: 10.1185/03007995.2013.857648.
    1. Bateman ED, Chapman KR, Singh D, D’Urzo AD, Molins E, Leselbaum A, et al. Aclidinium bromide and formoterol fumarate as a fixed-dose combination in COPD: pooled analysis of symptoms and exacerbations from two six-month, multicentre, randomised studies (ACLIFORM and AUGMENT) Respir Res. 2015;16:92. doi: 10.1186/s12931-015-0250-2.
    1. Miravitlles M, Ferrer J, Baro E, Lleonart M, Galera J. Differences between physician and patient in the perception of symptoms and their severity in COPD. Respir Med. 2013;107:1977–1985. doi: 10.1016/j.rmed.2013.06.019.
    1. Gimeno-Santos E, Frei A, Steurer-Stey C, de Batlle J, Rabinovich RA, Raste Y, et al. Determinants and outcomes of physical activity in patients with COPD: a systematic review. Thorax. 2014;69:731–739. doi: 10.1136/thoraxjnl-2013-204763.
    1. Troosters T, Sciurba F, Battaglia S, Langer D, Valluri SR, Martino L, et al. Physical inactivity in patients with COPD, a controlled multi-center pilot-study. Respir Med. 2010;104:1005–1011. doi: 10.1016/j.rmed.2010.01.012.
    1. Watz H, Waschki B, Meyer T, Magnussen H. Physical activity in patients with COPD. Eur Respir J. 2009;33:262–272. doi: 10.1183/09031936.00024608.
    1. Shrikrishna D, Patel M, Tanner RJ, Seymour JM, Connolly BA, Puthucheary ZA, et al. Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J. 2012;40:1115–1122. doi: 10.1183/09031936.00170111.
    1. Pleguezuelos E, Esquinas C, Moreno E, Guirao L, Ortiz J, Garcia-Alsina J, et al. Muscular dysfunction in COPD: systemic effect or deconditioning? Lung. 2016;194:249–257. doi: 10.1007/s00408-015-9838-z.
    1. Reardon JZ, Lareau SC, ZuWallack R. Functional status and quality of life in chronic obstructive pulmonary disease. Am J Med. 2006;119:32–37. doi: 10.1016/j.amjmed.2006.08.005.
    1. Troosters T, van der Molen T, Polkey M, Rabinovich RA, Vogiatzis I, Weisman I, et al. Improving physical activity in COPD: towards a new paradigm. Respir Res. 2013;14:115. doi: 10.1186/1465-9921-14-115.
    1. Jones PW, Watz H, Wouters EF, Cazzola M. COPD: the patient perspective. Int J Chron Obstruct Pulmon Dis. 2016;11 Spec Iss:13–20.
    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;61:772–778. doi: 10.1136/thx.2006.060145.
    1. Moy ML, Gould MK, Liu IA, Lee JS, Nguyen HQ. Physical activity assessed in routine care predicts mortality after a COPD hospitalisation. ERJ Open Res. 2016;2:eCollection 2016.
    1. Dury R. COPD and emotional distress: not always noticed and therefore untreated. Br J Community Nurs. 2016;21:138–141. doi: 10.12968/bjcn.2016.21.3.138.
    1. Pumar MI, Gray CR, Walsh JR, Yang IA, Rolls TA, Ward DL. Anxiety and depression-important psychological comorbidities of COPD. J Thorac Dis. 2014;6:1615–1631.
    1. Willgoss TG, Yohannes AM. Anxiety disorders in patients with COPD: a systematic review. Respir Care. 2013;58:858–866.
    1. Miravitlles M, Molina J, Quintano JA, Campuzano A, Pérez J, Roncero C. Factors associated with depression and severe depression in patients with COPD. Respir Med. 2014;108:1615–1625. doi: 10.1016/j.rmed.2014.08.010.
    1. Martinez Rivera C, Costan Galicia J, Alcázar Navarrete B, Garcia-Polo C, Ruiz Iturriaga LA, Herrejón A, et al. Factors associated with depression in COPD: a multicenter study. Lung. 2016;194:335–343. doi: 10.1007/s00408-016-9862-7.
    1. Ng TP, Niti M, Tan WC, Cao Z, Ong KC, Eng P. Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med. 2007;167:60–67. doi: 10.1001/archinte.167.1.60.
    1. Nunes DM, Mota RM, de Pontes Neto OL, Pereira ED, de Bruin VM, de Bruin PF. Impaired sleep reduces quality of life in chronic obstructive pulmonary disease. Lung. 2009;187:159–163. doi: 10.1007/s00408-009-9147-5.
    1. Valipour A, Lavie P, Lothaller H, Mikulic I, Burghuber OC. Sleep profile and symptoms of sleep disorders in patients with stable mild to moderate chronic obstructive pulmonary disease. Sleep Med. 2011;12:367–372. doi: 10.1016/j.sleep.2010.08.017.
    1. Cormick W, Olson LG, Hensley MJ, Saunders NA. Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease. Thorax. 1986;41:846–854. doi: 10.1136/thx.41.11.846.
    1. McNicholas WT, Verbraecken J, Marin JM. Sleep disorders in COPD: the forgotten dimension. Eur Respir Rev. 2013;22:365–375. doi: 10.1183/09059180.00003213.
    1. Scharf SM, Maimon N, Simon-Tuval T, Bernhard-Scharf BJ, Reuveni H, Tarasiuk A. Sleep quality predicts quality of life in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2010;6:1–12. doi: 10.2147/COPD.S15666.
    1. Omachi TA, Blanc PD, Claman DM, Chen H, Yelin EH, Julian L, et al. Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes. Sleep Med. 2012;13:476–483. doi: 10.1016/j.sleep.2011.12.007.
    1. Spina G, Spruit MA, Alison J, Benzo RP, Calverley PM, Clarenbach CF et al. Analysis of nocturnal actigraphic sleep measures in patients with COPD and their association with daytime physical activity. Thorax. 2017;Epub ahead of print.
    1. Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest. 2002;121:1434–1440. doi: 10.1378/chest.121.5.1434.
    1. Calverley PM. Cough in chronic obstructive pulmonary disease: is it important and what are the effects of treatment? Cough. 2013;9:17. doi: 10.1186/1745-9974-9-17.
    1. Burgel PR, Nesme-Meyer P, Chanez P, Caillaud D, Carré P, Perez T, et al. Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects. Chest. 2009;135:975–982. doi: 10.1378/chest.08-2062.
    1. Lindberg A, Sawalha S, Hedman L, Larsson LG, Lundback B, Ronmark E. Subjects with COPD and productive cough have an increased risk for exacerbations and death. Respir Med. 2015;109:88–95. doi: 10.1016/j.rmed.2014.12.001.
    1. Putcha N, Drummond MB, Connett JE, Scanlon PD, Tashkin DP, Hansel NN, et al. Chronic productive cough is associated with death in smokers with early COPD. COPD. 2014;11:451–458. doi: 10.3109/15412555.2013.837870.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren