Understanding the impact of symptoms on the burden of COPD

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.

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

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

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