Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey

ABSTRACT

Objective: To determine diurnal variability of symptoms in chronic obstructive pulmonary disease (COPD) and to assess the impact of COPD upon patients’ morning activities and routines.

Research design and methods: Quantitative internet interviews with 803 COPD patients from Europe and the USA, including 289 patients with severe COPD. Severe COPD was defined according to regular use of COPD medication, third level of breathlessness or above using the modified Medical Research Council (MRC) dyspnoea scale (MRC dyspnoea score ≥3) and one or more COPD exacerbations in the preceding 12 months.

Results: Morning was the worst time of day for COPD symptoms, particularly in patients with severe COPD (reported by 46% of severe patients). In these patients, shortness of breath was the most frequently reported symptom, correlating strongly with problems experienced with morning activities. Morning activities most affected by COPD were walking up and down stairs, putting on shoes and socks, making the bed, dressing, showering or bathing and drying. The majority of patients were not taking their medication in time for it to exert its optimal effect.

Conclusions: Many patients consider the impact of COPD on morning activities to be substantial. Physicians should question patients about morning activities to assess disease impact and to advise regarding the optimal time to use therapy. This was an internet-based questionnaire survey and possible bias in patient selection and self-reported diagnosis of COPD and its severity should be taken into account.

Keywords: :

• Chronic obstructive pulmonary disease
• Morning
• Questionnaire
• Symptoms

View correction statement:

Erratum

Transparency

Declaration of funding

This study and the journal publication support charges were funded by AstraZeneca. None of the authors received any honorarium for providing advice on the study design, interpretation of the results or preparation of the manuscript or for presenting the British Thoracic Society abstract. AstraZeneca has not reimbursed or paid for any travel expenses in connection with the abstract presentation. The authors take full responsibility for the views expressed in this article, which may not be shared by the sponsors.

Declaration of financial/other relationships

M.R.P. has disclosed that he is a recipient of lecture fees and fees for attendance at ad-hoc advisory boards from AstraZeneca, Chiesi, GlaxoSmithKline, Novartis and Teva; he holds no financial shareholdings in these companies. He has also disclosed being the recipient of research grants from the Astra Foundation, and assistance with the publication of a history of asthma charities from Novartis. N.K. has disclosed that he is a full-time employee of AstraZeneca and holds shares in the company. I.R.S. has disclosed that he is the recipient of travel grants (to attend international meetings) from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Pfizer, and that he is a trustee for the charity Asthma UK.

All peer reviewers receive honoraria from CMRO for their review work. Peer Reviewer 1 and Peer Reviewer 2 have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors thank Taylor Nelson Sofres for carrying out the internet survey, and Dr Cindy Macpherson from MediTech Media Ltd, who provided medical writing services and administrative support which were funded by AstraZeneca.

Data from this study were previously presented as an abstract at the British Thoracic Society Winter Meeting, London, 2008.