Table 3

Impact of medication on morning symptoms and physical activity

First author [ref.]MedicationMorning symptomsPhysical activity limitation associated with morning symptomsEffect medication on morning symptomsEffect intervention/medication on physical activity limitation due to morning symptoms
Bateman [15]Aclidinium bromide/formoterol94.4% of all patients90.6% of all patientsFDC 400/12 µg on severity scores: −0.23 units (−17.0%); aclidinium 400 µg: −0.14 units (−10.7%); formoterol 12 µg: −0.17 units (−13.6%) p<0.0001 versus aclidinium and p<0.01  versus formoterol#. Individual morning symptoms: p<0.05  versus aclidinium for cough and difficulty bringing up phlegm, and  versus both monotherapies for wheezing and shortness of breathImprovements in limitation of early morning activities: p<0.05  versus aclidinium and p<0.05 versus formoterol
OHagan [19]Patients were allowed to select any of their applied medicationMorning symptoms was an inclusion criterion in this studyImpact on normal activities was higher in those with morning symptoms compared to those without (3.96 versus 3.29; p<0.007)79% of COPD patients who feel medications provides relief from symptoms in the morning enough33% of patients considered “improvement of ability to carry out morning activities” a key treatment goal. 21% of patients feel medication provides improvement in the ability to carry out morning activities
Kim [18]No standard treatment for COPD was defined by the study protocol57% of all patients57% of all patientsLAMA and ICS plus LABA were used significantly less frequent in patients with morning symptoms. LAMA was a preventive factor for the presence of morning symptomsSeverity of all morning activities were significantly reduced after 2 months follow-up
  • COPD: chronic obstructive pulmonary disease; FDC: fixed-dose combination; LAMA: long-acting muscarinic antagonists; ICS: inhaled corticosteroids; LABA: long-acting β2-agonist. #: symptom severity measured on a score from 0 (no symptoms) to 4 (very severe symptoms).