ArticleNPJ primary care respiratory medicine2016
Morning and night symptoms in primary care COPD patients: a cross-sectional and longitudinal study. An UNLOCK study from the IPCRG.
Article in NPJ primary care respiratory medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 3 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Therapeutic efficacy and pharmacological mechanism of Bailing capsule on chronic obstructive pulmonary disease: a meta-analysis and network pharmacology.Pharmaceutical biology · 2024Pooled it
- Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review.Respiratory research · 2022Pooled it
- Daytime symptoms of chronic obstructive pulmonary disease: a systematic review.NPJ primary care respiratory medicine · 2020Pooled it
- Evening administration of long-acting muscarinic antagonists in COPD - a randomized controlled trial.BMC pulmonary medicine · 2025Trial
- High 24-Hour Respiratory Symptoms and Low Physical Activity in the Stable COPD Romanian Cohort of SPACE Study.International journal of chronic obstructive pulmonary diseaseTrial
- Cryptochrome Loss Drives COPD-like Lung Pathology through Disrupted Alveolar Epithelial Proliferation and Immune Homeostasis.bioRxiv : the preprint server for biology · 2026Article
- Effect of aclidinium bromide therapy on quality of life and symptoms of patients with chronic obstructive pulmonary disease: pooled analysis results of the Greek and Austrian ON-AIR real-world observational studies.BMC pulmonary medicine · 2026Observational
- Chronobiology in breathlessness across 24 h in people with persistent breathlessness.ERJ open research · 2025Article
- A Delphi Consensus Project to Capture Greek Experts' Opinion on the Position of Triple Therapies in COPD: Why, When and to Whom.International journal of chronic obstructive pulmonary disease · 2025Article
- Circadian Disruption in Night Shift Work and Its Association with Chronic Pulmonary Diseases.Advanced biology · 2023Review
- Circadian regulation of pulmonary disease: the importance of timing.Clinical science (London, England : 1979) · 2023Review
- Effect of chronic obstructive pulmonary disease combined with ventilator-associated pneumonia on patient outcomes: A systematic review and meta-analysis.Experimental and therapeutic medicine · 2020Article
- Symptom variability over the course of the day in patients with stable COPD in Brazil: a real-world observational study.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia · 2020Observational
- The Relationship Between Morning Symptoms and the Risk of Future Exacerbations in COPD.International journal of chronic obstructive pulmonary disease · 2020Article
- Prevalence of Asthma Characteristics in COPD Patients in a Dutch Well-Established Asthma/COPD Service for Primary Care.International journal of chronic obstructive pulmonary disease · 2020Article
- Day and Night Control of COPD and Role of Pharmacotherapy: A Review.International journal of chronic obstructive pulmonary disease · 2020Review
- A Real-World Observational Study Examining the Impact of Aclidinium Bromide Therapy on the Quality of Life, Symptoms, and Activity Impairment of Patients with Chronic Obstructive Pulmonary Disease: The Greek ON-AIR Study.International journal of chronic obstructive pulmonary disease · 2020Observational
- Importance of the relationship between symptoms and self-reported physical activity level in stable COPD based on the results from the SPACE study.Respiratory research · 2019Observational
- Impact of symptom variability on clinical outcomes in COPD: analysis of a longitudinal cohort.International journal of chronic obstructive pulmonary disease · 2019Article
- The association between objectively measured physical activity and morning symptoms in COPD.International journal of chronic obstructive pulmonary disease · 2017Observational
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
COPD symptoms show a diurnal variability. However, morning and night variability has generally not been taken into consideration in disease management plans. The aims of this study were to cross-sectionally assess morning and night symptom prevalence and correlation with health status and disease severity in COPD, and to determine to what extent they could predict longitudinal outcomes, exacerbations and health status. A further aim is to explore whether the CCQ is able to depict this morning/night symptomatology. We included 2,269 primary care COPD patients (58% male, 49% current smokers, with a mean age of 65±11 years) from a Dutch Asthma/COPD service. Spirometry, patient history, the Clinical COPD Questionnaire(CCQ) and the Asthma Control Questionnaire(ACQ) were assessed; we used the latter to evaluate morning (question 2) and night symptoms (question 1). A total of 1159 (51.9%) patients reported morning symptoms (ACQ question 2>0) and 879 (39.4%) had night complaints (ACQ question 1>0). Patients with morning/night symptoms were mostly smokers and had on average poorer lung function, higher CCQ scores and used more rescue inhalers (P<0.0001). Patients using long-acting muscarinic antagonists (LAMAs) had less night symptoms, showing a possible favourable effect. Only a small proportion of stable or slightly unstable patients (CCQ total scores <2) had severe morning symptoms (ACQ 2⩾4: n=19, 1.1%) or severe night symptoms (ACQ 1⩾4: n=11, 0.7%). Night symptoms seemed to predict future exacerbations; however, baseline exacerbations were the strongest predictors (n=346, OR:4.13, CI: 2.45-6.95, P<0.000). Morning symptoms increased the odds of poor health status at follow-up (n=346, OR:12.22, CI:4.76-31.39, P<0.000). Morning and night symptoms in COPD patients are common, and they are associated with poor health status and predicted future exacerbations. Our study showed that patients with morning/night symptoms have higher scores in CCQ, and therefore we do not really miss patients with high morning/night symptomatology when we only measure CCQ. Severe morning symptoms predicted worsening of COPD health status.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.