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02-02-2011 | Respiratory | Article

Significant symptom variability in patients with stable, severe COPD


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MedWire News: Patients with severe chronic obstructive pulmonary disease (COPD) report significant daily and weekly symptom variability even during so-called periods of stability, research shows.

The findings "have important implications for patients with severe COPD and may lead to improvements in how their condition is managed both day-to-day and over the long term," say lead researcher Romain Kessler (Nouvel Hôpital Civil, Strasbourg, France) and team.

The researchers studied 2441 patients with severe COPD from 17 European countries who were aged over 45 years. The participants had not experienced an exacerbation that required therapeutic intervention within the previous 3 months and were therefore considered to be stable. All of the patients were current or ex-smokers and had a FEV1 of less than 50% of the predicted value and a FEV1/forced vital capacity ratio of less than 0.7.

The participants completed a questionnaire detailing COPD symptoms and variability over the past day, week, and year, as well as sleep quality, tiredness, depression, anxiety, the impact of symptoms on morning and other daily activities, and changes in the use of maintenance and rescue medications in response to worsening symptoms.

In total, 2258 (92.5%) patients reported experiencing at least one COPD symptom (breathlessness, phlegm, cough, wheezing, or chest tightness) in the week before the interview, with breathlessness being the most common symptom (72.5%).

The majority of symptomatic patients (62.7%) perceived daily or weekly variability in one or more symptoms, with such symptoms having the greatest impact on morning activities.

Seasonal variation in respiratory symptoms was perceived by 59.5% of patients, with such symptoms being most severe during the winter.

However, although most participants experienced significant variability in COPD symptoms, 51.3% of these patients reported that they did not alter their treatment in response to worsening symptoms, with just 35.7% reporting increased use of rescue inhalers.

Kessler and team conclude in the European Respiratory Journal: "This study has shown that in between exacerbation periods, patients with severely impaired lung function often perceive both daily and weekly variability of their COPD symptoms and that the morning is the most troublesome time of day.

"Only a minority of patients seem to adapt their treatment in response to worsening of symptoms."

They add: "Further prospective longitudinal studies investigating COPD symptom variability and associated mechanisms are needed to shed more light on the extent of symptom variability and the impact this has on patients' normal routines."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Mark Cowen

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