Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 15

The Relationship Between Morning Symptoms and the Risk of Future Exacerbations in COPD

Authors Sun T, Li X, Cheng W, Peng Y, Zhao Y, Liu C, Zeng Y, Chen Y, Cai S, Chen P

Received 25 March 2020

Accepted for publication 15 July 2020

Published 5 August 2020 Volume 2020:15 Pages 1899—1907


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Tian Sun,1,2 Xiaoyun Li,3 Wei Cheng,1,2 Yating Peng,1,2 Yiyang Zhao,1,2 Cong Liu,1,2 Yuqin Zeng,1,2 Yan Chen,1,2 Shan Cai,1,2 Ping Chen1,2

1Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People’s Republic of China; 2Research Unit of Respiratory Disease, Central South University, Central South University, Changsha, Hunan 410011, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510000, People’s Republic of China

Correspondence: Ping ChenDepartment of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital 139 Renmin Middle Road, Changsha, Hunan 410011, People’s Republic of China
Tel +86-13873115563
Fax +86 731-85295848

Background: The morning is the most troublesome time of day for patients with chronic obstructive pulmonary disease (COPD). However, the association of morning symptoms and COPD exacerbations in longitudinal follow-up has not been studied. In this study, we mainly aimed to investigate the relationship between morning symptoms and exacerbations over a one-year follow-up period. And the secondary aim was an investigation of the association between morning symptoms and baseline clinical features.
Patients and Methods: Ninety-two patients with stable COPD provided the baseline information. Morning symptoms were assessed with the Chinese version of Chronic Obstructive Pulmonary Disease Morning Symptom Diary (Ch-COPD-MSD); the median morning symptoms score was used as a cut-off to separate the study cohort in two groups. Modified Medical Research Council (mMRC), COPD assessment test (CAT), and Clinical COPD Questionnaire (CCQ) were used and exacerbation history of the previous year was recorded. Seventy-eight patients (84.8%) completed the longitudinal follow-up of exacerbations.
Results: The median morning symptoms score was 30 in stable COPD patients. Morning symptoms severity was different between COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups (p< 0.001). Patients with high morning symptoms (score > 30) had higher scores of mMRC, CAT, and CCQ (p< 0.05). CAT score was an independent risk factor of morning symptoms. During follow-up, 41% of patients experienced ≥ 1 exacerbation. The frequency of severe exacerbations was higher in patients with high morning symptoms compared to patients with low morning symptoms (p< 0.005). The Ch-COPD-MSD score could predict future severe exacerbations; the area under the ROC curve was 0.751 (95% CI: 0.633– 0.868, p=0.002).
Conclusion: Worse health status and more dyspnea symptom were associated with increased severity of morning symptoms. Morning symptoms were most strongly related to future severe exacerbations and could predict future exacerbations in patients with COPD.

Keywords: chronic obstructive pulmonary disease, morning symptoms, future exacerbations

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]