It is now well accepted that chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease. Patients may present under different clinical characteristics and complain of a series of symptoms that may differ greatly from one individual to another. Although exacerbations are considered a central part of the disease, other features of the disease that might be of equal importance or indeed greater importance to many people have been neglected. Day-to-day symptoms from COPD limit activity, and the burden of these symptoms within the morning and resulting sleep disturbance may be more common than previously considered.
The magnitude of the burden of morning symptoms in COPD is addressed in this issue of Hot Topics in Respiratory Medicine by Martyn Partridge, who describes the innovative results obtained with his own research.
Recent investigations using interviews and questionnaires have demonstrated that symptoms vary throughout the day or week between exacerbation episodes, even during periods of stability. It is important to be able to quantify the impact of symptoms and their variability or intensity during different periods of the day. Romain Kessler addresses the description of some tools that have been developed specifically to evaluate these new concepts in COPD. With these instruments, it has been observed that a significant number of symptomatic patients complain of poor sleep quality, which can affect their sense of well-being in the morning. The variability of symptoms is associated with more severe breathlessness and more frequent exacerbations. These findings could have important implications for directing disease management for patients with COPD.
Regarding therapy, Peter Calverley describes the efficacy of pharmacological treatment in improving certain aspects of patients’ symptoms. In particular, he describes how in one large 1-year study the budesonide/formoterol combination showed greater improvements in health-related quality of life than the threshold that is considered clinically meaningful. The synergistic contributions of both formoterol and budesonide have an especially rapid onset of action leading to improvements in chronic symptoms that impact daily activities. There are now data from clinical trials that demonstrate the benefits arising from the rapid onset of action of the budesonide/formoterol combination in relieving the burden of morning symptoms.
COPD has been described as a complex disease. In this issue of Hot Topics the authors address a new aspect of respiratory symptoms that has an impact on patient’s well-being. The different patient-reported outcomes in COPD allow physicians to better understand unmet patients’ needs and to help direct therapy to the most relevant complaints for individuals suffering from this debilitating disease.