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      Evaluating the impact of morning symptoms in COPD using the Capacity of Daily Living during the Morning (CDLM) questionnaire

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          Abstract

          Purpose

          The aim of this study was to evaluate the impact of morning symptoms in COPD using the Capacity of Daily Living during the Morning (CDLM) questionnaire and to determine the clinical variables that are related to CDLM scores.

          Methods

          This was an observational, cross-sectional, and multicenter study conducted in stable COPD patients. CDLM scores ranged from 0 to 5 and were transformed into a qualitative variable according to tertile values to compare patient characteristics. A multivariate linear regression model was used to identify the clinical variables related to CDLM scores.

          Results

          A total of 605 patients were included in the study; the mean age (SD) was 68 years (9.1) and mostly were male (80.8%). The mean post-bronchodilator FEV 1% was 53.4% (19.2%), and the mean BODEx (body mass index, airway obstruction, dyspnea, exacerbation) score was 3.2 (2.0). The mean COPD assessment test (CAT) score was 16.6 (8.3), and the mean CDLM score was 4.2 (0.9). First tertile patients, that is, those with a higher impact in the morning, were older, had more respiratory symptoms, more dyspnea, a lower FEV 1%, lower CAT and BODEx scores, and more exacerbations. We found a ceiling effect on the CDLM scores: 194 (32%) patients scored 5.00 and no patients scored 0. On multivariate analysis, higher CAT and BODEx scores, a lower FEV 1%, and use of long-term oxygen therapy (LTOT) were all independently related to lower CDLM scores.

          Conclusion

          Morning respiratory symptoms are associated with more severe airflow obstruction, lower CAT and BODEx scores, and LTOT. The ceiling effect of the CDLM questionnaire does not allow it to discriminate well between low and high impact of morning symptoms.

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          Most cited references 19

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          Chronic obstructive pulmonary disease

          Summary Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction that is only partly reversible, inflammation in the airways, and systemic effects or comorbities. The main cause is smoking tobacco, but other factors have been identified. Several pathobiological processes interact on a complex background of genetic determinants, lung growth, and environmental stimuli. The disease is further aggravated by exacerbations, particularly in patients with severe disease, up to 78% of which are due to bacterial infections, viral infections, or both. Comorbidities include ischaemic heart disease, diabetes, and lung cancer. Bronchodilators constitute the mainstay of treatment: β2 agonists and long-acting anticholinergic agents are frequently used (the former often with inhaled corticosteroids). Besides improving symptoms, these treatments are also thought to lead to some degree of disease modification. Future research should be directed towards the development of agents that notably affect the course of disease.
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            Consensus document on the overlap phenotype COPD-asthma in COPD.

            Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured "brainstorming" method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale. Consensus was reached about the existence of a differential clinical phenotype known as"Overlap Phenotype COPD-Asthma", whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV(1) ≥ 15% and ≥ 400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV(1) ≥ 12% and ≥ 200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment. Copyright © 2011 SEPAR. Published by Elsevier Espana. All rights reserved.
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              Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients.

              1) To determine whether severe exacerbation of COPD is a BODE index independent risk factor for death; 2) whether the combined application of exacerbations and BODE (e-BODE index), offers greater predictive capacity than BODE alone or can simplify the model, by replacing the exercise capacity (BODEx index). A prospective study was made of a cohort of COPD patients. In addition to calculation of the BODE index we register frequency of exacerbations. An analysis was made of all-cause mortality, evaluating the predictive capacity of the exacerbations after adjusting for the BODE. These variables were also used to construct two new indexes: e-BODE and BODEx. The study included 185 patients with a mean age of 71+/-9 years, and FEV(1)% 47+/-17%. Severe exacerbation appeared as an independent adverse prognostic variable of BODE index. For each new exacerbation the adjusted mortality risk increased 1.14-fold (95% CI: 1.04-1.25). However, the e-BODE index (C statistic: 0.77, 95% CI: 0.67-0.86) didn't improve prognostic capacity of BODE index (C statistic: 0.75, 95% CI: 0.66-0.84) (p=NS). An interesting finding was that BODEx index (C statistic: 0.74, 95% CI: 0.65-0.83) had similar prognostic capacity than BODE index. Severe exacerbations of COPD imply an increased mortality risk that is independent of baseline severity of the disease as measured by the BODE index. The combined application of both parameters (e-BODE index) didn't improve the predictive capacity, but on replacing exacerbation with exercise capacity the multidimensional grading system is simplified without loss of predictive capacity.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2018
                26 November 2018
                : 13
                : 3837-3844
                Affiliations
                [1 ]Pneumology Department, Hospital Universitari Vall d’Hebron/Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, mmiravitlles@ 123456vhebron.net
                [2 ]Pneumology Department, Hospital Clínico de San Carlos, Madrid, Spain
                [3 ]Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
                [4 ]Medical Department, Novartis Farmaceutica, Barcelona, Spain
                [5 ]CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain, mmiravitlles@ 123456vhebron.net
                Author notes
                Correspondence: Marc Miravitlles, Pneumology, Department, Hospital Universitari Vall d’Hebron/Vall d’Hebron Institut de Recerca (VHIR), P. Vall d’Hebron 119-129, 08035 Barcelona, Spain, Tel +34 93 489 3000, Fax +34 93 274 8208, Email mmiravitlles@ 123456vhebron.net
                Article
                copd-13-3837
                10.2147/COPD.S179402
                6263249
                © 2018 Núñez et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Respiratory medicine

                cat, health-related quality of life, morning symptoms questionnaire, copd

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