The Relationship Between 24-Hour Symptoms and COPD Exacerbations and Healthcare Resource Use: Results from an Observational Study (ASSESS)

COPD Journal of Chronic Obstructive Pulmonary Disease, Taylor & Francis, ISSN 1541-2563

Volume 13, 5, 2016

DOI:10.3109/15412555.2016.1150447, Dimensions: pub.1022849302, PMID: 26983349,



  1. (1) Hospital Universitari Vall d'Hebron, grid.411083.f
  2. (2) b Facharztforum Fürth , Fürth , Germany.
  3. (3) Hospital Arnau de Vilanova, grid.413937.b
  4. (4) University of Aberdeen, grid.7107.1
  5. (5) University of Chieti-Pescara, grid.412451.7
  6. (6) Assistance Publique -Hopitaux De Paris, grid.50550.35
  7. (7) Hvidovre Hospital, grid.411905.8, Capital Region
  8. (8) University Medical Center Groningen, grid.4494.d
  9. (9) Skåne University Hospital, grid.411843.b
  10. (10) Almirall (Spain), grid.474012.4
  11. (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.

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