Evaluating the impact of morning symptoms in COPD using the Capacity of Daily Living during the Morning (CDLM) questionnaire

Figures & data

Table 1 Sociodemographic and clinical characteristics according to CDLM scores

Variables	Global N=605	T1 n=199	T2 n=212	T3 n=194	P-value
Age, years	68 (9.1)**	69.3 (8.2)**	68.9 (9.7)**	65.5 (8.8)**	<0.001b,c
Sex, male	488 (80.8%)	163 (82.3%)	164 (77.4%)	161 (83%)	0.285
Active smokers	171 (28.3%)	56 (28.1%)	56 (26.4%)	59 (30.4%)	0.670
Pack-years	43.9 (23.0)	44.3 (21.3)	42 (22.9)	45.5 (24.6)	0.299
BMI, kg/m^2	27.4 (4.5)**	27.2 (4.8)**	27.7 (4.6)**	27.4 (4.2)**	0.522
Symptoms
Chronic cough	75%	81.8%	77.3%	65.8%	0.001b,c
Expectoration	61.8%	72.7%	57.4%	55.7%	0.001a,b
Dyspnea	88%	96%	92.5%	75%	<0.001b,c
Wheezing	38.3%	49.5%	37.9%	27.1%	<0.001b
Dyspnea mMRC	1.8 (0.9)**	2.3 (0.8)**	1.8 (0.8)**	1.3 (0.8)**	<0.001a,b,c
FVC (mL)	2,856 (904)**	2,564 (802)**	2,695 (903)**	2,906 (866.7)**	<0.001b,c
FVC (%)	75.5 (22)**	70.7 (20)**	73.2 (18.4)**	77.5 (17.5)**	<0.001b
FEV1 (mL)	1,520 (577)**	1,320 (541)**	1,395 (541)**	1,536.1 (544)**	<0.001b,c
FEV1 (%)	53.4 (19.2)**	48.7 (20.7)**	50.9 (16)**	53.9 (15.7)**	<0.001a,b
GESEPOC phenotypes
Non-exacerbator	316 (52.6%)	66 (33.5%)	115 (54.5%)	135 (69.9%)	<0.001a,b,c
ACO	35 (5.8%)	13 (6.6%)	11 (5.2%)	11 (5.7%)	0.833
Exacerbator with emphysema	70 (11.6%)	23 (11.7%)	31 (14.3%)	16 (8.3%)	0.134
Exacerbator with chronic bronchitis	180 (30%)	95 (48.2%)	54 (25.6%)	31 (16.1%)	<0.001a,b
CAT score	16.6 (8.3)**	23.3 (6.8)**	15.7 (6.5)**	10.7 (6.2)**	<0.001a,b,c
BODEx	3.2 (2.0)**	4.8 (2.2)**	3.0 (2.0)**	2.0 (1.3)**	<0.001a,b,c
CDLM score	4.2 (0.9)**	3.1 (0.8)**	4.5 (0.2)**	5 (0.09)**	<0.001a,b,c
	4.5 (3.8; 5)*	3.3 (2.5; 3.8)*	4.5 (4.3; 4.7)*	5 (5; 5)*
Moderate/severe exacerbations last year	1.8 (1.8)**	2.6 (1.9)**	1.7 (1.6)**	1.16 (1.3)**	<0.001a,b,c
Exacerbations requiring hospitalization last year	0.5 (0.8)**	0.68 (0.94)**	0.44 (0.83)**	0.28 (0.59)**	<0.001a,b
COPD treatment
LAMA	84.4%	92.5%	80.8%	79.9%	0.001a,b
LABA	82%	83.9%	80.8%	80.9%	0.654
ICS	57%	69.3%	53.4%	48.5%	<0.001a,b
Long-term oxygen therapy	15.4%	28.1%	13.3%	4.6%	<0.001a,b,c

Notes:

* Median (interquartile range);

** mean (SD);

a P<0.05 for comparison between the T1 group and T2 group.

b P<0.05 for adjusted Bonferroni comparisons between the T1 group and T3 group.

c P<0.05 for adjusted Bonferroni comparisons between the T2 group and T3 group.

Abbreviations: ACO, asthma-COPD overlap; BMI, body mass index; BODEx index, Body mass index, airflow Obstruction, Dyspnea, Exacerbations; CAT, COPD assessment test; CDLM, Capacity of Daily Living during the Morning questionnaire; Dyspnea mMRC, modified Medical Research Council dyspnea scale; GESEPOC, COPD Spanish guideline (Guía Española de la EPOC); ICS, inhaled corticosteroids; LABA, long-acting ß2 agonist; LAMA, long-acting muscarinic antagonist; T1, tertile 1; T2, tertile 2; T3, tertile 3.

Figure 1 CDLM score according to clinical COPD phenotype.

Note: Data are expressed as mean (95% confidence interval) and median values (circles).
Abbreviations: ACOS, asthma–COPD overlap syndrome; CDLM, Capacity of Daily Living in the Morning questionnaire; ECB, exacerbator with chronic bronchitis; EE, exacerbator with emphysema; NE, non-exacerbator.

Figure 2 Linear relationship between CAT and CDLM score.

Abbreviations: CAT, COPD assessment test; CDLM, Capacity of Daily Living in the Morning questionnaire.

Figure 3 Linear relationship between FEV₁ (%) and CDLM score.

Abbreviation: CDLM, Capacity of Daily Living in the Morning questionnaire.

Figure 4 CDLM score according to BODEx index.

Note: Data are expressed as mean (95% confidence interval) and median values (circles).
Abbreviations: BODEx, Body mass index, airflow Obstruction, Dyspnea, Exacerbations; CDLM, Capacity of Daily Living in the Morning questionnaire.

Table 2 Stepwise multivariate multinomial regression model for CDLM tertiles

	OR	P-value	95% CI
			Lower limit	Upper limit
CDLM tertile 1 (<4.17)
Age (years)	1.040	0.016	1.007	1.073
Total CAT score	1.265	0.000	1.206	1.326
BODEx index score	1.331	0.001	1.116	1.587
Post-bronchodilator FEV1%	0.750	0.001	0.520	0.910
CDLM tertile 2 (4.17–5.00)
Age (years)	1.030	0.033	1.002	1.058
Total CAT score	1.098	0.000	1.056	1.143
BODEx index score	1.222	0.014	1.042	1.433
Post-bronchodilator FEV1%	0.860	0.001	0.752	0.910

Note: The reference category is 3rd tertile of CDLM.

Abbreviations: BODEX index, Body mass index, airflow Obstruction, Dyspnea, Exacerbations; CAT, COPD assessment test; CDLM, Capacity of Daily Living in the Morning questionnaire.