Impact of medication on morning symptoms and physical activity
| First author [ref.] | Medication | Morning symptoms | Physical activity limitation associated with morning symptoms | Effect medication on morning symptoms | Effect intervention/medication on physical activity limitation due to morning symptoms |
| Bateman [15] | Aclidinium bromide/formoterol | 94.4% of all patients | 90.6% of all patients | FDC 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 breath | Improvements in limitation of early morning activities: p<0.05 versus aclidinium and p<0.05 versus formoterol |
| O’Hagan [19] | Patients were allowed to select any of their applied medication | Morning symptoms was an inclusion criterion in this study | Impact 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 enough | 33% 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 protocol | 57% of all patients | 57% of all patients | LAMA and ICS plus LABA were used significantly less frequent in patients with morning symptoms. LAMA was a preventive factor for the presence of morning symptoms | Severity 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).