- (1) Hospital Universitari Vall d'Hebron, grid.411083.f
- (2) b Facharztforum Fürth , Fürth , Germany.
- (3) Hospital Arnau de Vilanova, grid.413937.b
- (4) University of Aberdeen, grid.7107.1
- (5) University of Chieti-Pescara, grid.412451.7
- (6) Assistance Publique -Hopitaux De Paris, grid.50550.35
- (7) Hvidovre Hospital, grid.411905.8, Capital Region
- (8) University Medical Center Groningen, grid.4494.d
- (9) Skåne University Hospital, grid.411843.b
- (10) Almirall (Spain), grid.474012.4
- (11) k Medical Affairs, AstraZeneca PLC , Barcelona , Spain.
This observational study assessed the relationship between nighttime, early-morning and daytime chronic obstructive pulmonary disease (COPD) symptoms and exacerbations and healthcare resource use. COPD symptoms were assessed at baseline in patients with stable COPD using a standardised questionnaire during routine clinical visits. Information was recorded on exacerbations and healthcare resource use during the year before baseline and during a 6-month follow-up period. The main objective of the analysis was to determine the predictive nature of current symptoms for future exacerbations and healthcare resource use. 727 patients were eligible (65.8% male, mean age: 67.2 years, % predicted forced expiratory volume in 1 second: 52.8%); 698 patients (96.0%) provided information after 6 months. Symptoms in any part of the day were associated with a prior history of exacerbations (all p < 0.05) and nighttime and early-morning symptoms were associated with the frequency of primary care visits in the year before baseline (both p < 0.01). During follow-up, patients with baseline symptoms during any part of the 24-hour day had more exacerbations than patients with no symptoms in each period (all p < 0.05); there was also an association between 24-hour symptoms and the frequency of primary care visits (all p ≤ 0.01). Although there was a significant association between early-morning and daytime symptoms and exacerbations during follow-up (both p < 0.01), significance was not maintained when adjusted for potential confounders. Prior exacerbations were most strongly associated with future risk of exacerbation. The results suggest 24-hour COPD symptoms do not independently predict future exacerbation risk.