High 24-Hour Respiratory Symptoms and Low Physical Activity in the Stable COPD Romanian Cohort of SPACE Study

Figures & data

Table 1 Socio-Demographic and Clinical Characteristics of Patients

Characteristic	N=406
Males, n (%)	339 (83.5)
Age, mean (SD), years	65.9 (8.5)
Educational level, n (%)
Primary school	42 (10.3)
Secondary school	141 (34.7)
High-school	172 (42.4)
University and post-university education	51 (12.6)
Employment status, n (%)
Retired	309 (76.1)
Employed	28 (6.9)
Unemployed	3 (0.7)
Other	7 (1.7)
Smoking history
Active smokers, n (%)	96 (23.6)
Former smokers, n (%)	310 (76.4)
Pack-years, mean (SD)	38.1 (23.8)
% predicted FEV1, mean (SD)	47.82 (16.2)
Post-BD FEV1/FVC, mean (SD)	0.55 (0.1)
COPD severity, n (%)
GOLD group I (mild)	11 (2.7)
GOLD group II (moderate)	176 (43.3)
GOLD group III (severe)	164 (40.4)
GOLD group IV (very severe)	55 (13.5)
mMRC
mMRC 0–1, n (%)	112 (27.6)
mMRC ≥2, n (%)	294 (72.4)
CAT
CAT score, mean (SD)	18.97 (8.2)
CAT <10	54 (13.3)
CAT ≥10	362 (86.7)
COTE index, mean (SD)	1.41 (1.9)
BODEx index, mean (SD)	3.04 (1.8)
Mean number of comorbidities per patient, mean (SD)	1.33 (1.0)
Exacerbations in previous 12 months
History of exacerbations, n (%)	282 (69.5)
Number of COPD exacerbations/patient, mean (SD)	1.97 (2.7)
History of severe exacerbations in last year, n (%)	75 (18.5)
Number of mild exacerbations/patient, mean (SD)	0.29 (0.7)

Abbreviations: BD, bronchodilator; BODEx, body mass index, obstruction, dyspnea and exacerbations; CAT, COPD Assessment Test; COPD, Chronic Obstructive Pulmonary Disease; COTE, COPD specific comorbidities test; FEV₁, Forced Expiratory Volume in 1 second; FVC, Forced Vital Capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified Medical Research Council; SD, standard deviation.

Figure 1 Distribution of patients in ABCD groups using the 2013 (A) and 2017 (B) GOLD edition.

Abbreviations: CAT, COPD Assessment Test; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified Medical Research Council.

Figure 2 Prevalence of individual respiratory symptoms assessed by questionnaires corresponding for each part of the 24-h day EMSCI, NiSCI and E-RS™:COPD.

Note: Wheezing is not assessed with the derivative instrument of E-RS™:COPD.

Abbreviations: 24-h, 24-hour; EMSCI, Early Morning Symptoms of COPD Instrument; E-RS™:COPD, Evaluating Respiratory Symptoms in COPD; NiSCI, Nighttime Symptoms of COPD Instrument.

Figure 3 The physical activity level assessed by Investigators (clinical judgment) and self-assessed by patients (EVS questions).

Note: *Expressed in minutes/week of moderate to vigorous exercise.

Abbreviations: EVS, Exercise as Vital Sign; min, minutes.

Table 2 Physical Activity Results – YPAS Dimensions

Characteristic	N=406
YPAS checklist total time (min/week), mean (SD)	1549.3 (1258.7)
Energy expenditure summary index (kcal/week), mean (SD)	5685.0 (4841.1)
Vigorous activity index score, mean (SD)	10.2 (12.5)
Leisurely walking index score, mean (SD)	18.6 (14.3)
Moving index score, mean (SD)	7.2 (3.3)
Standing index score, mean (SD)	6.7 (3.4)
Sitting index score, mean (SD)	2.6 (1.1)
Summary index, mean (SD)	45.3 (24.6)
Seasonal adjustment score, mean (SD)	1.0 (0.1)

Abbreviations: SD, standard deviation; YPAS, Yale Physical Activity Survey.

Table 3 Relationship Between 24-h Respiratory Symptoms Severity Score and Patients’ Outcomes

	Early Morning Symptoms			Daytime Symptoms			Night-Time Symptoms
	Correlation Coefficient R	Coefficient of Determination R^2	P-value	Correlation Coefficient R	Coefficient of Determination R^2	P-value	Correlation Coefficient R		Coefficient of Determination R^2	P-value
PAL
Investigator’s assessment	−0.272	0.074	<0.001	−0.338	0.114	<0.001	−0.251		0.063	<0.001
EVS	−0.303	0.092	<0.001	−0.324	0.105	<0.001	−0.304		0.092	<0.001
YPAS checklist total time	−0.081	0.006	0.110	−0.115	0.013	0.023	−0.130		0.017	0.009
Energy expenditure summary index	−0.095	0.009	0.061	−0.140	0.020	0.005	−0.142		0.020	0.004
YPAS total score	−0.173	0.030	0.001	−0.293	0.086	<0.001	−0.200		0.040	<0.001
Other outcomes
CAT	0.702	0.493	<0.001	0.748	0.560	<0.001	0.614		0.377	<0.001
Comorbidities (COTE)	0.017	0.000	0.739	0.040	0.002	0.431	0.089		0.008	0.075
Number of comorbidities	0.008	0.000	0.878	0.038	0.001	0.455	0.028		0.001	0.571
BODEx	0.389	0.151	<0.001	0.462	0.213	<0.001	0.339		0.115	<0.001
mMRC	0.424	0.180	<0.001	0.526	0.277	<0.001	0.392		0.154	<0.001
Post-BD FEV1 predicted	−0.192	0.037	<0.001	−0.229	0.052	<0.001	−0.146		0.021	0.003
Post-BD FEV1/FVC %	−0.134	0.018	0.008	−0.171	0.029	0.001	−0.080		0.006	0.110
Number of severe exacerbations	0.166	0.028	0.001	0.178	0.032	<0.001	0.111		0.012	0.026
Number of exacerbations	0.264	0.070	<0.001	0.272	0.074	<0.001	0.216		0.047	<0.001
Exacerbation history	0.175	0.031	<0.001	0.159	0.025	0.002	0.185		0.034	<0.001

Note: The Pearson’s correlation coefficient was used.

Abbreviations: BD, bronchodilator; BODEx, body mass index, obstruction, dyspnea and exacerbations; CAT, COPD Assessment Test; COPD, Chronic Obstructive Pulmonary Disease; COTE, COPD specific comorbidities test; EVS, Exercise Vital Sign; FEV₁, Forced Expiratory Volume in 1 second; FVC, Forced Vital Capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified Medical Research Council; PAL, physical activity level; YPAS, Yale Physical Activity Survey.

Table 4 Relationship Between Physical Activity and Patients’ Outcomes

	EVS			YPAS Total Score
	Correlation Coefficient R	Coefficient of Determination R^2	P-value	Correlation Coefficient R	Coefficient of Determination R^2	P-value
CAT	−0.291	0.085	<0.001	−0.353	0.125	<0.001
Comorbidities (COTE)	0.034	0.001	0.496	−0.140	0.020	0.005
Number of comorbidities	0.101	0.010	0.042	−0.057	0.003	0.251
BODEx	−0.353	0.124	<0.001	−0.425	0.181	<0.001
mMRC	−0.432	0.186	<0.001	−0.475	0.225	<0.001
Post-BD FEV1 predicted	0.200	0.040	<0.001	0.242	0.059	<0.001
Post-BD FEV1/FVC %	0.152	0.023	0.002	0.187	0.035	<0.001
Number of severe exacerbations	−0.074	0.005	0.137	−0.197	0.039	<0.001
Number of exacerbations	−0.147	0.021	0.003	−0.226	0.051	<0.001
Exacerbation history	−0.073	0.005	0.143	−0.201	0.040	<0.001

Note: The Pearson’s correlation coefficient was used.

Abbreviations: BD, bronchodilator; BODEx, body mass index, obstruction, dyspnea and exacerbations; CAT, COPD Assessment Test; COPD, Chronic Obstructive Pulmonary Disease; COTE, COPD specific comorbidities test; EVS, Exercise Vital Sign; FEV₁, Forced Expiratory Volume in 1 second; FVC, Forced Vital Capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified Medical Research Council; PAL, physical activity level; YPAS, Yale Physical Activity Survey.