The relationship between morning symptoms and related clinical features in patients with chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SUN Tian , LI Xiaoyun , PENG Yating , CHENG Wei , ZENG Yuqin , ZHAO Yiyang , LIU Cong , CAI Shan , CHEN Yan ,  CHEN Ping

Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, P. R. China;

Corresponding author：

CHEN Ping, Email: pingchen0731@sina.com

Keywords：

Chronic obstructive pulmonary disease; Morning symptoms; Clinical features; Related factors

DOI：

10.7507/1671-6205.202006054

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the relationship between morning symptoms and other clinical characteristics in patients with chronic obstructive pulmonary disease (COPD), and to look for related risk factors affecting morning symptoms.Methods This cross-sectional observational study included 153 patients with stable COPD. Morning symptoms were evaluated with the Chinese-version of Chronic Obstructive Pulmonary Disease Morning Symptom Diary (Ch-COPD-MSD). And modified version of the British medical association respiratory questionnaire (mMRC), COPD assessment test (CAT), questionnaire clinical COPD questionnaire (CCQ) score were scored, and the BODEx index was calculated.Results A total of 153 stable COPD patients were included. The patients aged 59.6±7.6 years with a mean forced expiratory volume in one second of (52.0±20.7)% predicted (FEV₁%pred). The median score of morning symptoms was 31.00. Morning symptoms severity was different between GOLD groups A to D: median (interquartile range) score in GOLD A was 23.50 (20.00 - 27.25), in GOLD B was 31.00 (26.00 - 38.00), in GOLD C was 30.00 (23.75 - 35.75), and in GOLD D was 36.50 (27.00 - 47.50) (P<0.001). Meanwhile, under different mMRC, CAT, CCQ scores, the difference in the median score of morning symptoms was statistically significant (all P=0.000). Score of morning symptoms was negatively correlated with the FEV₁%pred (r=–0.24, P<0.001), and positively correlated with the score of mMRC, CAT, CCQ, and the BODEx index (r value was 0.50, 0.60, 0.53, 0.40, respectively, P<0.001). Multiple linear regression analysis showed that CAT score was the important factor associated with morning symptoms severity in COPD (B=0.829, P<0.001).Conclusions Morning symptoms are associated with multiple clinical indicators for assessing the severity of COPD, and health status is the most strongly associated with morning symptoms. Clinical evaluation of morning symptoms in patients with COPD can be helpful in comprehensive assessment of the patient’s condition.

Citation： SUN Tian, LI Xiaoyun, PENG Yating, CHENG Wei, ZENG Yuqin, ZHAO Yiyang, LIU Cong, CAI Shan, CHEN Yan, CHEN Ping. The relationship between morning symptoms and related clinical features in patients with chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(6): 381-387. doi: 10.7507/1671-6205.202006054 Copy

1.	Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
2.	Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717.
3.	World Health Organization. World Health Organization (WHO) Website. 2019. [2019-10-14].http://www.who.int.
4.	Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J, 2011, 37(2): 264-272.
5.	Partridge MR, Karlsson N, Small IR. Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey [published correction appears in Curr Med Res Opin. 2012 Aug: 28(8): 1405]. Curr Med Res Opin, 2009, 25(8): 2043-2048.
6.	Stephenson JJ, Cai Q, Mocarski M, et al. Impact and factors associated with nighttime and early morning symptoms among patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2015, 10: 577-586.
7.	Miravitlles M, Worth H, Soler Cataluña JJ, et al. Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study. Respir Resm, 2014, 15(1): 122.
8.	Miravitlles M, Izquierdo JL, Esquinas C, et al. The variability of respiratory symptoms and associated factors in COPD. Respir Med, 2017, 129: 165-172.
9.	Globe G, Currie B, Leidy NK, et al. Development of the chronic obstructive pulmonary disease morning symptom diary (COPD-MSD). Health Qual Life Outcomes, 2016, 14(1): 104.
10.	Marin JM, Beeh KM, Clemens A, et al. Early bronchodilator action of glycopyrronium versus tiotropium in moderate-to-severe COPD patients: a cross-over blinded randomized study (Symptoms and Pulmonary function in the moRnING). Int J Chron Obstruct Pulmon Dis, 2016, 11: 1425-1434.
11.	Partridge MR, Miravitlles M, Ståhl E, et al. Development and validation of the Capacity of Daily Living during the Morning questionnaire and the Global Chest Symptoms Questionnaire in COPD. Eur Respir J, 2010, 36(1): 96-104.
12.	李晓云, 成玮, 段佳熙, 等. 慢性阻塞性肺疾病晨间症状量表中文版研制及信效度验证. 中华结核和呼吸杂志, 2019, 42(6): 444-450.
13.	Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax, 1999, 54(7): 581-586.
14.	Jones PW, Quirk FH, Baveystock CM, et al. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis, 1992, 145(6): 1321-1327.
15.	Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J, 2009, 34(3): 648-654.
16.	van der Molen T, Willemse BW, Schokker S, et al. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes, 2003, 1: 13.
17.	Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med, 2004, 350(10): 1005-1012.
18.	Soler-Cataluña JJ, Martínez-García MA, Sánchez LS, et al. Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. Respir Med, 2009, 103(5): 692-699.
19.	Roche N, Small M, Broomfield S, et al. Real world COPD: association of morning symptoms with clinical and patient reported outcomes. COPD, 2013, 10(6): 679-686.
20.	Jones PW, Adamek L, Nadeau G, et al. Comparisons of health status scores with MRC grades in COPD: implications for the GOLD 2011 classification. Eur Respir J, 2013, 42(3): 647-654.
21.	Jones PW, Tabberer M, Chen WH. Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT^TM) scores. BMC Pulm Med, 2011, 11: 42.
22.	Kon SS, Canavan JL, Nolan CM, et al. The clinical chronic obstructive pulmonary disease questionnaire: cut point for GOLD 2013 classification. Am J Respir Crit Care Med, 2014, 189(2): 227-228.
23.	Zhou Z, Zhou A, Zhao Y, et al. A comparison of the assessment of health status between CCQ and CAT in a Chinese COPD clinical population: a cross-sectional analysis. Int J Chron Obstruct Pulmon Dis, 2018, 13: 1675-1682.
24.	Lu M, Wang X, Cai B, et al. Perception of circadian variation of symptoms in Chinese patients with chronic obstructive pulmonary disease. J Thorac Dis, 2017, 9(10): 3888-3895.
25.	van Buul AR, Kasteleyn MJ, Chavannes NH, et al. The association between objectively measured physical activity and morning symptoms in COPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 2831-2840.
26.	Kuyucu T, Güçlü SZ, Saylan B, et al. A cross-sectional observational study to investigate daily symptom variability, effects of symptom on morning activities and therapeutic expectations of patients and physicians in COPD-SUNRISE study. Tuberk Toraks, 2011, 59(4): 328-339.
27.	Tsiligianni I, Metting E, van der Molen T, et al. Morning and night symptoms in primary care COPD patients: a cross-sectional and longitudinal study. An UNLOCK study from the IPCRG. NPJ Prim Care Respir Med, 2016, 26: 16040.
28.	Wu M, Wang Z, Li M, et al. Daily symptom variability in patients with stable COPD: a narrative review. West J Nurs Res, 2018, 40(10): 1543-1561.

1. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
2. Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717.
3. World Health Organization. World Health Organization (WHO) Website. 2019. [2019-10-14].http://www.who.int.
4. Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J, 2011, 37(2): 264-272.
5. Partridge MR, Karlsson N, Small IR. Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey [published correction appears in Curr Med Res Opin. 2012 Aug: 28(8): 1405]. Curr Med Res Opin, 2009, 25(8): 2043-2048.
6. Stephenson JJ, Cai Q, Mocarski M, et al. Impact and factors associated with nighttime and early morning symptoms among patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2015, 10: 577-586.
7. Miravitlles M, Worth H, Soler Cataluña JJ, et al. Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study. Respir Resm, 2014, 15(1): 122.
8. Miravitlles M, Izquierdo JL, Esquinas C, et al. The variability of respiratory symptoms and associated factors in COPD. Respir Med, 2017, 129: 165-172.
9. Globe G, Currie B, Leidy NK, et al. Development of the chronic obstructive pulmonary disease morning symptom diary (COPD-MSD). Health Qual Life Outcomes, 2016, 14(1): 104.
10. Marin JM, Beeh KM, Clemens A, et al. Early bronchodilator action of glycopyrronium versus tiotropium in moderate-to-severe COPD patients: a cross-over blinded randomized study (Symptoms and Pulmonary function in the moRnING). Int J Chron Obstruct Pulmon Dis, 2016, 11: 1425-1434.
11. Partridge MR, Miravitlles M, Ståhl E, et al. Development and validation of the Capacity of Daily Living during the Morning questionnaire and the Global Chest Symptoms Questionnaire in COPD. Eur Respir J, 2010, 36(1): 96-104.
12. 李晓云, 成玮, 段佳熙, 等. 慢性阻塞性肺疾病晨间症状量表中文版研制及信效度验证. 中华结核和呼吸杂志, 2019, 42(6): 444-450.
13. Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax, 1999, 54(7): 581-586.
14. Jones PW, Quirk FH, Baveystock CM, et al. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis, 1992, 145(6): 1321-1327.
15. Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J, 2009, 34(3): 648-654.
16. van der Molen T, Willemse BW, Schokker S, et al. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes, 2003, 1: 13.
17. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med, 2004, 350(10): 1005-1012.
18. Soler-Cataluña JJ, Martínez-García MA, Sánchez LS, et al. Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients. Respir Med, 2009, 103(5): 692-699.
19. Roche N, Small M, Broomfield S, et al. Real world COPD: association of morning symptoms with clinical and patient reported outcomes. COPD, 2013, 10(6): 679-686.
20. Jones PW, Adamek L, Nadeau G, et al. Comparisons of health status scores with MRC grades in COPD: implications for the GOLD 2011 classification. Eur Respir J, 2013, 42(3): 647-654.
21. Jones PW, Tabberer M, Chen WH. Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT^TM) scores. BMC Pulm Med, 2011, 11: 42.
22. Kon SS, Canavan JL, Nolan CM, et al. The clinical chronic obstructive pulmonary disease questionnaire: cut point for GOLD 2013 classification. Am J Respir Crit Care Med, 2014, 189(2): 227-228.
23. Zhou Z, Zhou A, Zhao Y, et al. A comparison of the assessment of health status between CCQ and CAT in a Chinese COPD clinical population: a cross-sectional analysis. Int J Chron Obstruct Pulmon Dis, 2018, 13: 1675-1682.
24. Lu M, Wang X, Cai B, et al. Perception of circadian variation of symptoms in Chinese patients with chronic obstructive pulmonary disease. J Thorac Dis, 2017, 9(10): 3888-3895.
25. van Buul AR, Kasteleyn MJ, Chavannes NH, et al. The association between objectively measured physical activity and morning symptoms in COPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 2831-2840.
26. Kuyucu T, Güçlü SZ, Saylan B, et al. A cross-sectional observational study to investigate daily symptom variability, effects of symptom on morning activities and therapeutic expectations of patients and physicians in COPD-SUNRISE study. Tuberk Toraks, 2011, 59(4): 328-339.
27. Tsiligianni I, Metting E, van der Molen T, et al. Morning and night symptoms in primary care COPD patients: a cross-sectional and longitudinal study. An UNLOCK study from the IPCRG. NPJ Prim Care Respir Med, 2016, 26: 16040.
28. Wu M, Wang Z, Li M, et al. Daily symptom variability in patients with stable COPD: a narrative review. West J Nurs Res, 2018, 40(10): 1543-1561.

Next Article
Invasive high-flow oxygen therapy and invasive-noninvasive ventilation sequential strategies for chronic obstructive pulmonary disease patients with severe respiratory failure: a randomized controlled trial

Chinese Journal of Respiratory and Critical Care Medicine

The relationship between morning symptoms and related clinical features in patients with chronic obstructive pulmonary disease

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content