Upper respiratory symptoms worsen over time and relate to clinical phenotype in chronic obstructive pulmonary disease.
BACKGROUND
How nasal symptoms in patients with chronic obstructive pulmonary disease (COPD) change over time and resolve during naturally occurring exacerbations has not been described previously.


OBJECTIVE
To evaluate the evolution and impact of upper airway symptoms in a well-defined COPD cohort when stable and at exacerbation.


METHODS
Patients in the London COPD cohort were asked about the presence of nasal symptoms (nasal discharge, sneezing, postnasal drip, blocked nose, and anosmia) over an 8-year period (2005-2013) every 3 months at routine clinic visits while in a stable state and daily during exacerbations with the use of diary cards. Data were prospectively collected, and, in a subgroup of patients, COPD Assessment Test scores and human rhinovirus identification by polymerase chain reaction were available. Patients were also defined as having infrequent or frequent exacerbations (<2 or ≥2 exacerbations/yr, respectively).


RESULTS
At an aggregate of 4,368 visits, 209 patients with COPD were asked about their nasal symptoms. At 2,033 visits when the patients were stable, the odds ratio (OR) for nasal discharge increased by 1.32% per year (95% confidence interval [CI], 1.19-1.45; P < 0.001); the OR for sneezing increased by 1.16% (95% CI, 1.05-1.29; P = 0.005); the OR for postnasal drip increased by 1.18% (95% CI, 1.03-1.36; P = 0.016); and the OR for anosmia increased by 1.19% (95% CI, 1.03-1.37; P = 0.015). At visits when the patients were having exacerbations, nasal discharge was present for 7 days and blocked nose, sneezing, and postnasal drip increased for just 3 days. Anosmia did not change. Nasal discharge was more likely in patients with frequent exacerbations (OR, 1.96; 95% CI, 1.17-3.28; P = 0.011), and COPD Assessment Test scores were higher by 1.06 units (95% CI, 0.32-1.80; P = 0.005) when patients were stable and higher by 1.30 units (95% CI, 0.05-2.57; P = 0.042) during exacerbations.


CONCLUSIONS
Upper airway symptoms increase over time in patients with COPD and are related to the frequent exacerbation phenotype. These longitudinal changes may be due to increasing airway inflammation or to progression of COPD.
1 Medicine Section, Emergency Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer, and.|2 Institut Clínic del Tòrax, Servei de Pneumologia, Hospital Clinic de Barcelona, CIBER de Enfermedades Respiratorias 06/06/0028, Barcelona, Spain; and.|3 Airways Disease Section, Imperial College London, Royal Brompton Hospital, London, United Kingdom.
Arturo
http://orcid.org/0000-0002-6191-4143
A
Huerta
3 Airways Disease Section, Imperial College London, Royal Brompton Hospital, London, United Kingdom.
Gavin C
GC
Donaldson
3 Airways Disease Section, Imperial College London, Royal Brompton Hospital, London, United Kingdom.
Richa
R
Singh
3 Airways Disease Section, Imperial College London, Royal Brompton Hospital, London, United Kingdom.
Alex J
AJ
Mackay
3 Airways Disease Section, Imperial College London, Royal Brompton Hospital, London, United Kingdom.
James P
JP
Allinson
3 Airways Disease Section, Imperial College London, Royal Brompton Hospital, London, United Kingdom.
Simon E
SE
Brill
3 Airways Disease Section, Imperial College London, Royal Brompton Hospital, London, United Kingdom.
Beverly
B
Kowlessar
2 Institut Clínic del Tòrax, Servei de Pneumologia, Hospital Clinic de Barcelona, CIBER de Enfermedades Respiratorias 06/06/0028, Barcelona, Spain; and.
Antoni
A
Torres
3 Airways Disease Section, Imperial College London, Royal Brompton Hospital, London, United Kingdom.
Jadwiga A
JA
Wedzicha
D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000150:complications*; D016017:Odds Ratio; D000857:Olfaction Disorders / Q000150:complications*; D010641:Phenotype; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D011788:Quality of Life; D012229:Rhinovirus / Q000302:isolation & purification; D012720:Severity of Illness Index; D012912:Sneezing; D013183:Sputum / Q000821:virology
COPD; COPD Assessment Test score; phenotype; upper respiratory symptoms