title: The Relationship Between 24-Hour Symptoms and COPD Exacerbations and Healthcare Resource Use: Results from an Observational Study (ASSESS).
abstract: This observational study assessed the relationship between nighttime, early-morning and daytime chronic obstructive pulmonary disease (COPD) symptoms and exacerbations and healthcare resource use. COPD symptoms were assessed at baseline in patients with stable COPD using a standardised questionnaire during routine clinical visits. Information was recorded on exacerbations and healthcare resource use during the year before baseline and during a 6-month follow-up period. The main objective of the analysis was to determine the predictive nature of current symptoms for future exacerbations and healthcare resource use. 727 patients were eligible (65.8% male, mean age: 67.2 years, % predicted forced expiratory volume in 1 second: 52.8%); 698 patients (96.0%) provided information after 6 months. Symptoms in any part of the day were associated with a prior history of exacerbations (all p < 0.05) and nighttime and early-morning symptoms were associated with the frequency of primary care visits in the year before baseline (both p < 0.01). During follow-up, patients with baseline symptoms during any part of the 24-hour day had more exacerbations than patients with no symptoms in each period (all p < 0.05); there was also an association between 24-hour symptoms and the frequency of primary care visits (all p ≤ 0.01). Although there was a significant association between early-morning and daytime symptoms and exacerbations during follow-up (both p < 0.01), significance was not maintained when adjusted for potential confounders. Prior exacerbations were most strongly associated with future risk of exacerbation. The results suggest 24-hour COPD symptoms do not independently predict future exacerbation risk.
authors.affiliation: a Pneumology Department , Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.affiliation: b Facharztforum Fürth , Fürth , Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Worth
authors.affiliation: c Servicio de Neumología, Hospital Arnau de Vilanova , Valencia , Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Soler-Cataluña
authors.affiliation: d Centre of Academic Primary Care, University of Aberdeen , Aberdeen , UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: e Specialization School in Internal Medicine , G. D'Annunzio, University of Chieti , Chieti , Italy.
authors.forename: Fernando
authors.initials: F
authors.lastname: De Benedetto
authors.affiliation: f Cochin Hospital, AP-HP, Paris Descartes University (EA2511) EA2511 , Paris , France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: g Department of Respiratory Medicine , Hvidovre University Hospital , Hvidovre , Denmark.
authors.forename: Nina S
authors.initials: NS
authors.lastname: Godtfredsen
authors.affiliation: h Department of Primary care , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: i Department of Respiratory Medicine and Allergology , Lund University Hospital , Lund , Sweden.
authors.forename: Claes-Göran
authors.initials: CG
authors.lastname: Löfdahl
authors.affiliation: j Medical Affairs, Almirall S.A. , Barcelona , Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Padullés
authors.affiliation: k Medical Affairs, AstraZeneca PLC , Barcelona , Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Ribera
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D005544:Forecasting; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D000067251:Symptom Flare Up; D013997:Time Factors
keywords: Cohort; exacerbation risk; morning symptoms; nighttime symptoms; prospective; retrospective