title: Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey.
abstract: OBJECTIVE
  To determine diurnal variability of symptoms in chronic obstructive pulmonary disease (COPD) and to assess the impact of COPD upon patients' morning activities and routines.
  
  
  METHODS
  Quantitative internet interviews with 803 COPD patients from Europe and the USA, including 289 patients with severe COPD. Severe COPD was defined according to regular use of COPD medication, third level of breathlessness or above using the modified Medical Research Council (MRC) dyspnoea scale (MRC dyspnoea score > or =3) and one or more COPD exacerbations in the preceding 12 months.
  
  
  RESULTS
  Morning was the worst time of day for COPD symptoms, particularly in patients with severe COPD (reported by 46% of severe patients). In these patients, shortness of breath was the most frequently reported symptom, correlating strongly with problems experienced with morning activities. Morning activities most affected by COPD were walking up and down stairs, putting on shoes and socks, making the bed, dressing, showering or bathing and drying. The majority of patients were not taking their medication in time for it to exert its optimal effect.
  
  
  CONCLUSIONS
  Many patients consider the impact of COPD on morning activities to be substantial. Physicians should question patients about morning activities to assess disease impact and to advise regarding the optimal time to use therapy. This was an internet-based questionnaire survey and possible bias in patient selection and self-reported diagnosis of COPD and its severity should be taken into account.
authors: Imperial College London, NHLI Division, Charing Cross Hospital, London W6 8RP, UK. m.partridge@imperial.ac.uk
authors: Martyn R
authors: MR
authors: Partridge
authors: Niklas
authors: N
authors: Karlsson
authors: Iain R
authors: IR
authors: Small
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002940:Circadian Rhythm; D005260:Female; D006306:Health Surveys; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013997:Time Factors