COPD symptoms in the morning: impact, evaluation and management

Abstract

Chronic obstructive pulmonary disease (COPD) symptoms in the morning, including dyspnea and sputum production, affect patients' quality of life and limit their ability to carry out even simple morning activities. It is now emerging that these symptoms are associated with increased risk of exacerbations and work absenteeism, suggesting that they have a more profound impact on patients than previously thought. The development of validated patient-reported outcome (PRO) questionnaires to capture patients' experience of COPD symptoms in the morning is, therefore, vital for establishing effective and comprehensive management strategies. Although it is well established that long-acting bronchodilators are effective in improving COPD symptoms, the limited available data on their impact on morning symptoms and activities have been obtained with non-validated PRO questionnaires. In this review, we discuss the impact of COPD symptoms in the morning and available tools used to evaluate them, and highlight specific gaps that need to be addressed to develop standardized instruments able to meet regulatory requirement. We also present available evidence on the effect of pharmacological therapies on morning symptoms.

Figure 1

Time when COPD symptoms are worse than usual as reported by patients. *p < 0.001 versus midday, afternoon, evening, night and difficult to say group; p = 0.006 versus no particular time of the day; ^†p < 0.001 versus midday. Copyright © 2009, Informa Healthcare. Reproduced with permission of Informa Healthcare [3].

Figure 2

Patients who had reported experiencing symptoms in the previous 7 days were asked during what times of the day the symptoms were most troublesome: a) Breathlessness, n = 1,769; b) phlegm, n = 1,551; c) cough, n = 1,433; d) wheezing, n = 1,018; and e) chest tightness, n = 690. © 2002 European Respiratory Society. Reproduced with permission of the European Respiratory Society [7].