Association between morning symptoms and physical activity in COPD: a systematic review

Abstract

Morning symptoms are common in chronic obstructive pulmonary disease (COPD). Many COPD patients consider the morning as the most troublesome part of the day, in which they experience more symptoms and physical activity limitations.To systematically report evidence of the association between morning symptoms and physical activity in COPD patients, a literature search was conducted using relevant MESH terms and text words in PubMed, Embase, Web of Science, COCHRANE, CINAHL and PsycINFO. Quality of the articles was assessed with validated checklists.Eight studies were included. Morning symptoms were present in 39.8-94.4%. In 37.0-90.6% of all COPD patients, there was an association between physical activity and morning symptoms. However, causality could not be proved. Morning symptoms were associated with a sedentary lifestyle (p<0.05). Treatment in line with the guidelines improved the degree of activity limitations due to morning symptoms (p<0.0001).Across all disease stages, COPD patients experience morning symptoms which are negatively associated with physical activity. Physicians should consider morning symptoms as a treatment goal. Pharmacotherapy may improve the degree of activity limitations due to morning symptoms. More objective research should focus on symptoms, activity limitations and physical inactivity of COPD patients, especially in the morning.

Figure 1

Study flow diagram with the use of the official PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow chart.

Figure 2

Occurrence of morning symptoms. a) In all studied chronic obstructive pulmonary disease (COPD) patients. b) Occurrence of different morning symptoms in COPD patients experiencing symptoms. c) Symptomatic COPD patients who report the morning as worst time of the day for that symptom (results for at waking and the rest of the morning are combined). ^#: Classification of airflow limitation according to Global initiative for Chronic Obstructive Lung Disease (GOLD); ^¶: “severe” was defined in this study as regular use of COPD medication plus a third level of breathlessness or above using the Medical Research Council dyspnoea scale and one or more exacerbations in the preceding 12 months ⁺: in all included COPD patients.