From: Understanding the impact of symptoms on the burden of COPD
Study | Measures | Association(s) |
---|---|---|
Quality of life | ||
 Miravitlles et al. Respir Med. 2007 [11] | Patient questionnaire (daily wellbeing and COPD symptoms) | Increased coughing, followed by increasing shortness of breath, fatigue, and increased production of sputum were reported as having a strong impact on wellbeing |
 Jones et al. Prim Care Respir J. 2012 [4] | SGRQ (quality of life) CAT (quality of life) MRC scale (dyspnea) Patient questionnaire (symptoms) | Dyspnea grade, PCP-rated COPD severity, sputum production and number of comorbidities were significantly associated with SGRQ and CAT score (all p < 0.0001) |
 Price et al. Int J Chron Obstruct Pulmon Dis. 2013 [13] | EQ-5D (quality of life) Physician record (COPD symptoms time of day) | Patients with physician-reported nighttime symptoms had significantly poorer quality of life (p < 0.0001) |
 Monteagudo et al. Respir Med. 2013 [12] | SGRQ (quality of life) Patient interview (chronic respiratory symptoms) | Cough and sputum and increased dyspnea were associated with a significant worsening of HRQoL (all p < 0.001) |
 Miravitlles et al. Respir Res. 2014 [3] | CAT score (quality of life) Patient questionnaire (COPD symptoms) | Overall health status was significantly lower in patients with at least one symptom in the morning, daytime, or nighttime (p < 0.001) |
 Stephenson et al. Int J Chron Obstruct Pulmon Dis. 2015 [27] | CAT score (quality of life) Patient questionnaire (COPD symptoms) | Patients with both nighttime and early-morning symptoms were more likely to have poorer health status (OR 8.03; 95% CI 4.33, 14.89) |
Physical activity | ||
 Partridge et al. Curr Med Res Opin. 2009 [17] | Patient questionnaire (COPD symptoms) | The impact of COPD symptoms on morning activities is substantial, with dyspnea being the most problematic |
 Kessler et al. Eur Respir J. 2011 [5] | Patient questionnaire (COPD symptoms and impact on daily activities) | Morning symptoms of COPD had the greatest impact on daily living activities |
 O’Hagan and Chavannes. Curr Med Res Opin. 2014 [28] | Patient questionnaire (COPD symptoms and impact on daily activities) | With morning symptoms, routine activities took 10–15 min longer and more strenuous activities around 30 min longer |
 Stephenson et al. Int J Chron Obstruct Pulmon Dis. 2015 [27] | Patient questionnaire (COPD symptoms and limitation of activities) | 60.4% of patients reported limiting their morning activity due to early-morning symptoms |
 Miravitlles et al. Respir Res. 2014 [3] | Patient questionnaire (COPD symptoms time of day and physical activity levels) | A higher proportion of patients who were sedentary had symptoms in the morning, daytime, and nighttime compared with active patients |
Depression | ||
 Ng et al. Arch Intern Med. 2007 [46] | HADS (depression) SGRQ (COPD symptom burden and QoL) | Increased symptom burden in patients with depression (p < 0.001) |
 Doyle et al. Int J Psychiatry Med. 2013 [16] | State-Trait Anxiety Inventory (anxiety) Beck Depression Inventory (depression) Brief Fatigue Inventory (fatigue) SGRQ (COPD symptoms) UCSD Shortness of Breath Questionnaire (dyspnea) 6MWT (functional capacity) | Anxiety and depression associated with higher fatigue, dyspnea, and frequency of COPD symptoms (all p < 0.001); more so in patients with lower functional capacity (p = 0.02–0.009) |
 Miravitlles et al. Respir Med. 2014 [44] | Beck Depression Inventory (depression) mMRC scale (dyspnea) | Greater dyspnea in patients with depression vs no depression (mean dyspnea grade: 2.07 vs 1.32; p < 0.0001) |
 Miravitlles et al. Respir Res. 2014 [3] | HADS (depression) Patient questionnaire (COPD symptoms time of day) | Experiencing symptoms in the morning, daytime, and nighttime was associated with anxiety and depression (p < 0.001) |
 Martinez Rivera et al. Lung 2016 [45] | HADS (depression) MRC scale (dyspnea) | Greater dyspnea in patients with depression |
Sleep | ||
 Partridge et al. Curr Med Res Opin. 2009 [17] | Patient questionnaire (COPD symptoms) | Patients experiencing general fatigue and tiredness reported worse nighttime symptoms (p = 0.003) |
 Kessler et al. Eur Respir J. 2011 [5] | Patient interview (sleep and COPD symptoms) | A quarter of the total study population reported that their COPD symptoms had affected sleep quality |
 Scharf et al. Int J Chron Obstruct Pulmon Dis. 2011 [51] | Pittsburgh Sleep Quality Index (sleep) Sleep Symptom Questionnaire (nighttime sleep symptoms of COPD) | Sleep time correlated with the number of nocturnal symptoms such as wheezing, worrying, and uncontrolled thoughts (p < 0.0001). Specific respiratory symptoms were not significantly associated with low sleep times |
 Omachi et al. Sleep Med. 2012 [52] | Medical Outcomes Study sleep battery (sleep) MRC scale (dyspnea) Patient interview (dyspnea and cough) | Patients with cough symptoms had three-fold greater likelihood of disturbed sleep (p = 0.034) The degree of dyspnea was associated with a higher likelihood of disturbed sleep (p = 0.004) |
 Price et al. Int J Chron Obstruct Pulmon Dis. 2013 [13] | Jenkins Sleep Questionnaire Seven-point Likert scale Frequency of nocturnal awakening | Patients with nighttime symptoms are significantly more likely to experience sleep disturbance vs those without nighttime symptoms (p < 0.0001) |
 Miravitlles et al. Respir Res. 2014 [3] | COPD and Asthma Sleep Impact Scale (sleep quality) Symptom questionnaire (COPD symptoms time of day) | Experiencing symptoms in the morning, daytime, and nighttime was associated with sleep impairment (p < 0.001) |
Exacerbations and disease prognosis | ||
 Nishimura et al. Chest 2002 [54] | Modified 5-point grading scale (dyspnea) 5-year cumulative survival rate (mortality) | The level of dyspnea was associated with a lower 5-year survival rate (p < 0.001) |
 Burgel et al. Chest 2009 [56] | Patient questionnaire (COPD symptoms and exacerbations) Medical records (exacerbations) | Productive cough was independently associated with frequent exacerbations (≥2 in the previous year) (p < 0.0001) |
 Lange et al. Eur Respir J. 2014 [21] | Patient questionnaire (COPD symptoms) Hospital admissions data (previous and follow-up exacerbations) | Patients with nighttime dyspnea were more likely to have had ≥2 exacerbations in the previous year (p < 0.001). Nighttime symptoms were associated with future exacerbations (HR 2.3; 95% CI 1.7, 3.0) |
 Putcha et al. COPD 2014 [58] | Patient questionnaire (COPD symptoms) Mortality data (mortality) | Cough and phlegm symptoms together were associated with an increased risk of mortality (HR 1.27; 95% CI 1.02, 1.59) |
 Lindberg et al. Respir Med. 2015 [57] | Patient interview (COPD symptoms and exacerbations) Mortality data (mortality) | Patients with a productive cough have an increased risk of exacerbations (OR 9.25; 95% CI 6.23, 13.75), and a significantly increased risk of mortality (HR 1.48; 95% CI 1.13, 1.94) |
 Miravitlles et al. COPD 2016 [25] | Patient questionnaire (COPD symptoms) Hospital admissions data (follow-up exacerbations) | Early-morning and daytime symptoms were associated with exacerbations during follow-up (both p < 0.01), however significance was not maintained when adjusted for potential confounding factors |