Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study

Alberto Cukier, Irma de Godoy, Claudia Henrique da Costa, Adalberto Sperb Rubin, Marcelo Gervilla Gregorio, Aldo Agra de Albuquerque Neto, Marina Andrade Lima, Monica Corso Pereira, Suzana Erico Tanni, Rodrigo Abensur Athanazio, Elizabeth Jauhar Cardoso Bessa, Fernando Cesar Wehrmeister, Cristina Bassi Lourenco, Ana Maria Baptista Menezes, Alberto Cukier, Irma de Godoy, Claudia Henrique da Costa, Adalberto Sperb Rubin, Marcelo Gervilla Gregorio, Aldo Agra de Albuquerque Neto, Marina Andrade Lima, Monica Corso Pereira, Suzana Erico Tanni, Rodrigo Abensur Athanazio, Elizabeth Jauhar Cardoso Bessa, Fernando Cesar Wehrmeister, Cristina Bassi Lourenco, Ana Maria Baptista Menezes

Abstract

Objective: To analyze symptoms at different times of day in patients with COPD.

Methods: This was a multicenter, cross-sectional observational study conducted at eight centers in Brazil. We evaluated morning, daytime, and nighttime symptoms in patients with stable COPD.

Results: We included 593 patients under regular treatment, of whom 309 (52.1%) were male and 92 (15.5%) were active smokers. The mean age was 67.7 years, and the mean FEV1 was 49.4% of the predicted value. In comparison with the patients who had mild or moderate symptoms, the 183 (30.8%) with severe symptoms were less physically active (p = 0.002), had greater airflow limitation (p < 0.001), had more outpatient exacerbations (p = 0.002) and more inpatient exacerbations (p = 0.043), as well as scoring worse on specific instruments. The most common morning and nighttime symptoms were dyspnea (in 45.2% and 33.1%, respectively), cough (in 37.5% and 33.3%, respectively), and wheezing (in 24.4% and 27.0%, respectively). The intensity of daytime symptoms correlated strongly with that of morning symptoms (r = 0.65, p < 0.001) and that of nighttime symptoms (r = 0.60, p < 0.001), as well as with the COPD Assessment Test score (r = 0.62; p < 0.001), although it showed only a weak correlation with FEV1 (r = -0.205; p < 0.001).

Conclusions: Dyspnea was more common in the morning than at night. Having morning or nighttime symptoms was associated with greater daytime symptom severity. Symptom intensity was strongly associated with poor quality of life and with the frequency of exacerbations, although it was weakly associated with airflow limitation.

Trial registration: ClinicalTrials.gov NCT03381560.

Conflict of interest statement

CONFLICTS OF INTEREST: AMBM and FCW received financial support from AstraZeneca do Brasil for the statistical analysis. AC received financial support from AstraZeneca do Brasil for the writing of the manuscript. CBL is an employee of AstraZeneca do Brasil.

Figures

Figure 1. Prevalence and intensity of morning…
Figure 1. Prevalence and intensity of morning symptoms (in A) and nighttime symptoms (in B).
Figure 2. Associations between the intensity of…
Figure 2. Associations between the intensity of daytime and nighttime symptoms and the prevalence of morning and nighttime symptoms.

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