COPD Patients With Nighttime and/or Early Morning Symptoms: Quality of Life and Dyspnea

Abstract

PURPOSE: To assess quality of life (QoL) and dyspnea among chronic obstructive pulmonary disease (COPD) patients with/without nighttime (NT) and/or early morning (EM) symptoms. METHOD(S): This study consisted of a cross-sectional patient survey. Administrative claims from the HealthCore Integrated Research Database were utilized to identify commercially insured patients, aged >=40 years, with >=1 medical claim with an ICD-9-CM diagnosis code of COPD or >=1 pharmacy claim for COPD maintenance medication between 09/01/2010-08/31/2011. Consenting respondents completed a 25-minute survey including screening questions which classified them as having NT/EM symptoms based on whether they experienced symptoms >=3 nights/mornings in the past week. Survey recruitment was stratified based on NT/EM symptoms to maximize balance across groups. Respondents completed the Short Form-12 version 2 (SF-12v2), the COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. Analysis of variance and chi-square tests were used to evaluate differences among groups. RESULT(S): Of 752 respondents completing the survey, 42.3% reported having both NT/EM symptoms, 32.7% reported either NT or EM symptoms, and 25.0% reported neither. Mean (+/-SD) age was 60.2 (+/-8.0) years and the majority of respondents were female (60.5%), white (91.6%), and former/current smokers (87.1%). Respondents with EM symptoms experienced EM symptoms for an average of 5.2 (+/-5.0) years. Respondents with NT symptoms experienced NT symptoms for an average of 5.4 (+/-5.8) years. Compared to respondents without symptoms, those with both or either NT/EM symptoms reported lower mean SF-12v2 Physical Component Summary scores (PCS: both, 34.0 vs either, 38.6 vs neither, 43.8; p<0.01) and Mental Component Summary scores (MCS: both, 47.0 vs either, 52.8 vs neither, 54.3; p<0.01), as well as higher mean CAT scores (both, 21.6 vs either, 13.8 vs neither, 9.1; p<0.01) and mMRC grade (both, 1.8 vs either, 1.1 vs neither, 0.8; p<0.01), indicating a greater impact of COPD symptoms and dyspnea for respondents with both or either symptoms. CONCLUSION(S): COPD patients with NT/EM symptoms reported lower physical QoL scores and a greater impact of COPD symptoms and dyspnea compared with patients without symptoms.