Morning Symptoms

An international survey of 803 COPD patients found that morning was the worst time of day for patients with COPD, especially those with severe disease10 (Figure 2).

The graph shows the time when COPD symptoms are worse than normal.

Figure 2. Many patients report mornings as being the worst time of day for experiencing COPD symptoms and performing daily activities.10,11 The graph shows the time when COPD symptoms are worse than normal.
Morning was defined as from the time respondents woke up until they were dressed, had breakfast and were ready to start the day; midday as the time around lunch; afternoon as the time before they had dinner; evening as from the time they had dinner until they went to bed; and night as from the time they went to bed until they woke up in the morning. Multiple answers were possible. 
*p<0.001 vs ‘midday’, ‘afternoon’, ‘evening’, ‘night’ and ‘difficult to say’ groups; p=0.006 vs ‘no particular time of day’ (all patients with COPD);
p<0.001 vs ‘midday’, ‘afternoon’, ‘evening’, ‘no particular time of day’ and ‘difficult to say’ groups; p=0.001 vs ‘night’. Data are weighted for age and severity.11

Shortness of breath was the most frequently-reported symptom and had a strong correlation with performing morning activities, such as walking up and down the stairs, putting on shoes and socks and making the bed 10 (Figure 3).

Breathlessness affects simple morning activities.

Figure 3. Breathlessness affects simple morning activities10
*Rated on a scale from 1 to 10, where 1=it is not affected at all and 10=it is greatly affected.
Data are weighted for age and COPD severity.

The majority of patients in this study were not taking their medication in time for it to exert its optimal effect, indicating a need for long-acting medication and advice to patients on the optimal time to administer their therapy.

Other studies have also shown that the severity and nature of COPD symptoms varies over time. For example, a study of Turkish patients with COPD indicated that variability in the symptoms of dyspnoea, sputum production and cough reached a peak in the morning hours, whereas wheezing peaked at night and angina peaked during the day.12 In a Spanish study, 84% of patients with COPD reported at least one respiratory symptom in the previous week and 61% noted that their symptoms varied over the course of the day or week, with the most intense symptoms occurring in the morning.13

The impact of the common COPD symptoms on patients’ lives was evaluated in a recent survey that revealed that these symptoms significantly affect patients’ routine activities, such as waking and carrying out simple tasks (e.g. stairs, shower, grooming, and dressing). The time to complete these simple activities was extended by 10-15 minutes for the patients, while more strenuous activities (doing morning chores around the house) took around 30 minutes longer than previously.14 The multiple symptoms have a significant impact on patient wellbeing1,3,15–19 (Figure 4).

The multiple symptoms of COPD have a significant impact on patient well-being.

Figure 4. The multiple symptoms of COPD have a significant impact on patient well-being1,3,15–19