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Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study

Variabilidade dos sintomas diários de pacientes com DPOC estável no Brasil: um estudo observacional de vida real

Alberto Cukier1, Irma de Godoy2, Claudia Henrique da Costa3, Adalberto Sperb Rubin4, Marcelo Gervilla Gregorio5, Aldo Agra de Albuquerque Neto6, Marina Andrade Lima7, Monica Corso Pereira8, Suzana Erico Tanni2, Rodrigo Abensur Athanazio1, Elizabeth Jauhar Cardoso Bessa3, Fernando Cesar Wehrmeister9, Cristina Bassi Lourenco10, Ana Maria Baptista Menezes9

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METHODS S1 Inclusion criteria * Age ≥ 40 years * Diagnosis of COPD at least 1 year prior * Post-bronchodilator FEV1/FVC ratio < 0.70 * Smoker or former smoker with a ≥ 10 pack-year smoking history * Stable disease (without exacerbations or changes in maintenance treatment in the last 2 months) Exclusion criteria * Diagnosis of sleep apnea syndrome * Other chronic respiratory diseases or any acute or chronic condition that, in the opinion of the researcher, could limit the ability of the participant to fill out the questionnaires or participate in the study SYMPTOM QUESTIONNAIRES Morning symptoms were analyzed with the Early Morning Symptoms of COPD Instrument.(27) It was designed to measure three concepts of interest in patients with COPD: 1. occurrence and severity of six morning symptoms ("Did you feel any of the following symptoms this morning?: cough, wheezing, shortness of breath, chest tightness, chest congestion, or difficulty expectorating?") and general severity of symptoms ("If so, what was the intensity of the symptom: mild, moderate, intense, or very intense?"); 2. impact of those symptoms in terms of the limitation of morning activities ("To what extent did the symptoms limit your activities this morning?"); and 3. use of rescue medication ("How many inhalations of the rescue medication did you use this morning?"). Nighttime symptoms were analyzed with the Nighttime Symptoms of COPD Instrument,(28) which is based on the Early Morning Symptoms of COPD Instrument(27) and measures the following concepts of interest: 1. occurrence and severity of six nighttime symptoms and their intensity; 2. impact of these symptoms in terms of nocturnal awakenings ("Did you wake up last night because of your COPD symptoms?"; and "How many times did you wake up because of your COPD symptoms?"); and 3. use of rescue medication ("How many inhala-tions of the rescue medication did you use last night?).

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