Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 8

Symptom variability in COPD: a narrative review

Authors Lopez-Campos JL, Calero C, Quintana-Gallego E

Received 16 January 2013

Accepted for publication 7 March 2013

Published 7 May 2013 Volume 2013:8 Pages 231—238


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Jose Luis Lopez-Campos,1,2 Carmen Calero,1,2 Esther Quintana-Gallego1,2

1Unidad Medico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio, Seville, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain

Abstract: Chronic obstructive pulmonary disease (COPD) has traditionally been considered an inexorably progressive disease, associated with a constant increase of symptoms that occur as the forced expiratory volume in 1 second (FEV1) worsens, only intermittently interrupted by exacerbations. However, this paradigm has been challenged in recent decades by the available evidence. Recent studies have pointed out that COPD-related symptoms are not consistently perceived by patients in the same way, showing not only seasonal variation, but also changes in symptom perception during a week or even within a single day. According to the available data, patients experience the biggest increase in respiratory symptoms during the first hours of the early morning, followed by the nighttime. This variation over time is of considerable importance, since it impacts on daily life activities and health-related quality of life, as measured by a recently developed ad hoc questionnaire. Additionally, recent clinical trials have suggested that the use of rapid-onset long-acting bronchodilators may have an impact on morning symptoms, despite their current use as maintenance treatment for a determined period. Although this hypothesis is to be validated in future long-term clinical trials comparing fast-onset versus slow-onset inhaled drugs in COPD, it may bring forward a new concept of long-term bronchodilator therapy. At the present time, the two available long-acting, fast-onset bronchodilators used in the treatment of COPD are formoterol and the recently marketed indacaterol. Newer drugs have also been shown to have a rapid onset of action in preclinical studies. Health care professionals caring for COPD patients should consider this variation in the perception of symptoms during their clinical interview as a potential new target in the long-term treatment plan.

Keywords: symptom perception, rapid-onset bronchodilators, indacaterol, formoterol, glycopyrronium, aclidinium

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]


Other articles by this author:

Double bronchodilation in chronic obstructive pulmonary disease: a crude analysis from a systematic review

Lopez-Campos JL, Calero-Acuña C, Márquez-Martín E, Quintana Gallego E, Carrasco-Hernández L, Abad Arranz M, Ortega Ruiz F

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:1867-1876

Published Date: 23 June 2017

Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit

López-Campos JL, Abad Arranz M, Calero-Acuña C, Romero-Valero F, Ayerbe-García R, Hidalgo-Molina A, Aguilar-Pérez-Grovas RI, García-Gil F, Casas-Maldonado F, Caballero-Ballesteros L, Sánchez-Palop M, Pérez-Tejero D, Segado Soriano A, Calvo-Bonachera J, Hernández-Sierra B, Doménech A, Arroyo-Varela M, González-Vargas F, Cruz-Rueda JJ

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:785-792

Published Date: 3 March 2017

Determinants for changing the treatment of COPD: a regression analysis from a clinical audit

López-Campos JL, Abad Arranz M, Calero Acuña C, Romero Valero F, Ayerbe García R, Hidalgo Molina A, Aguilar Perez-Grovas RI, García Gil F, Casas Maldonado F, Caballero Ballesteros L, Sánchez Palop M, Pérez-Tejero D, Segado A, Calvo Bonachera J, Hernández Sierra B, Doménech A, Arroyo Varela M, González Vargas F, Cruz Rueda JJ

International Journal of Chronic Obstructive Pulmonary Disease 2016, 11:1171-1178

Published Date: 2 June 2016

Evaluation of the COPD Assessment Test and GOLD patient types: a cross-sectional analysis

Lopez-Campos JL, Fernandez-Villar A, Calero-Acuña C, Represas-Represas C, Lopez-Ramírez C, Fernández VL, Soler-Cataluña JJ, Casamor R

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:975-984

Published Date: 27 May 2015

Patient-reported outcomes and considerations in the management of COPD: focus on aclidinium

Lopez-Campos JL, Calero C, Lopez-Ramirez C, Asensio-Cruz MI, Márquez-Martín E, Ortega-Ruiz F

Patient Preference and Adherence 2015, 9:95-104

Published Date: 17 January 2015

Modified BODE indexes: Agreement between multidimensional prognostic systems based on oxygen uptake

José Luis Lopez-Campos, Pilar Cejudo, Eduardo Marquez, et al

International Journal of Chronic Obstructive Pulmonary Disease 2010, 5:133-140

Published Date: 4 May 2010

Readers of this article also read:

Indacaterol: a comprehensive review

Rossi A, Polese G

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:353-363

Published Date: 25 July 2013

The development and pilot testing of the Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD)

Apps LD, Mitchell KE, Harrison SL, Sewell L, Williams JE, Young HML, Steiner M, Morgan M, Singh SJ

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:317-327

Published Date: 9 July 2013

The association between COPD and heart failure risk: a review

de Miguel Díez J, Chancafe Morgan J, Jiménez García R

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:305-312

Published Date: 28 June 2013

A comparison of three multidimensional indices of COPD severity as predictors of future exacerbations

Motegi T, Jones RC, Ishii T, Hattori K, Kusunoki Y, Furutate R, Yamada K, Gemma A, Kida K

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:259-271

Published Date: 31 May 2013