Table 1

Overall conclusion and quality of included studies

First author [ref.]Study designParticipants' characteristics at baselineOverall conclusionQuality
Bateman [15]Pooled analysis from two phase III double-blind, randomised, parallel-group active- and placebo-controlled studiesn=3394; age ≥40 years; stable moderate-to-severe COPDAclidinium/formoterol 400/12 μg significantly improves 24-h symptom control compared with placebo or aclidinium or formoterol alone. The frequency of exacerbations was also reduced compared with placebo17/25#,¶
Stephenson [20]Cross-sectional survey studyn=752; 60.5% female; age ≥40 years; COPD plus at least one pharmacy claim for maintenance COPD medicationThe majority of the patients with night time or morning symptoms experience at least three distinct types of symptoms a week. Approximately half of them consider their symptoms to be moderate to severe. They felt that their symptoms had impact on their sleep and morning activities, and they were anxious18/22+
Miravitlles [16]Observational studyn=727; 34.2% female; age ≥40 years; current of former smokers; stable mild-to-very-severe COPDMore than half of COPD patients experience symptoms throughout the whole day. There was a significant association between night time, early morning and daytime symptoms. In each period, symptoms were associated with worse patient-reported outcomes18/22+
OHagan [19]Observational studyn=811; 44% female; age 30–70 years; COPD diagnosed by a physician; at least one morning symptomMorning symptoms can severely interfere with COPD patients’ ability to perform tasks throughout the day. Half of the patients had made changes in their morning routines15/22+
Roche [17]Cross-sectional observational studyn=1489; 34.3% female; age ≥40 years; with a history of smoking, airflow obstruction and the diagnosis of COPD39.8% of the COPD patients experience morning symptoms. Morning symptoms are associated with poorer health status, impaired daily activities and increased risk of exacerbations16/22+
Kim [18]Prospective non-interventional and observational studyn=133; 5.3% female; age >45 years; with a history of smoking; stable severe-to-very severe COPD57% of COPD patients experience limitation in their activities due to morning symptoms. These patients also have more prevalent and severe COPD symptoms14/22+
Kessler [22]Cross-sectional observational studyn=2441; 21.5% female; age >45 years; with a history of smoking; stable severe-to-very severe COPDPatient-perceived COPD symptoms vary over the day and the week, and have impact on activities. The morning was considered the worst time of the day16/22+
Partridge [21]Quantitative internet interviewsn=803; 44% female; age ≥40 years; with a history of smoking; all stages of COPDCOPD are worst during the morning. Many patients consider the impact of COPD on morning activities to be extensive17/22+
  • COPD: chronic obstructive pulmonary disease; #: CONSORT (Consolidated Standards of Reporting Trials) was used as a tool to assess quality; : pooled analysis from two studies; +: STROBE (Strengthening the Reporting of Observational studies in Epidemiology) was used as a tool used to assess quality.