Circadian rhythm of COPD symptoms in clinically based phenotypes. Results from the STORICO Italian observational study

Nicola Scichilone,Raffaele Antonelli Incalzi,Giorgio Walter Canonica,Francesco Blasi,Giuseppina Cuttitta,Alessandro Zullo,Alessandra Ori,Pietro Schino

doi:10.1186/s12890-019-0935-2

Abstract

BackgroundChronic Obstructive Pulmonary Disease (COPD) encompasses various phenotypes that severely limit the applicability of precision respiratory medicine. The present investigation is aimed to assess the circadian rhythm of symptoms in pre-defined clinical COPD phenotypes and its association with health-related quality of life (HR-QoL), the quality of sleep and the level of depression/anxiety in each clinical phenotype.MethodsThe STORICO (NCT03105999) Italian observational prospective cohort study enrolled COPD subjects. A clinical diagnosis of either chronic bronchitis (CB), emphysema (EM) or mixed COPD-asthma (MCA) phenotype was made by clinicians at enrollment. Baseline early-morning, day-time and nocturnal symptoms (gathered via the Night-time, Morning and Day-time Symptoms of COPD questionnaire), HR-QoL (via the St. George’s Respiratory Questionnaire), anxiety and depression levels (via the Hospital Anxiety and Depression Scale), quality of sleep (via COPD and Asthma Sleep Impact Scale), physical activity (via the International Physical Activity Questionnaire) as well as lung function were recorded.Results606 COPD subjects (age 71.4 ± 8.2 years, male 75.1%) were studied. 57.9, 35.5 5.3 and 1.3% of the sample belonged to the CB, EM, MCA and EM + CB phenotypes respectively. The vast majority of subjects reported early-morning and day-time symptoms (79.5 and 79.2% in the CB and 75.8 and 77.7% in the EM groups); the proportion suffering from night-time symptoms was higher in the CB than in the EM group (53.6% vs. 39.5%, p = 0.0016). In both CB and EM, indiscriminately, the presence of symptoms during the 24-h day was associated with poorer HR-QoL, worse quality of sleep and higher levels of anxiety/depression.ConclusionsThe findings highlight the primary classificatory role of nocturnal symptoms in COPD.Trial registrationTrial registration number: NCT03105999, date of registration: 10th April 2017.

Highlights

Chronic Obstructive Pulmonary Disease (COPD) encompasses various phenotypes that severely limit the applicability of precision respiratory medicine
One effort to classify COPD individuals according to their clinical presentations is the Spanish COPD guidelines [3], which distinguish the emphysema from the Scichilone et al BMC Pulmonary Medicine (2019) 19:171 chronic bronchitic phenotype and consider the rate of exacerbations
To reinforce the classical phenotyping strategy, this paper aims primarily to assess, within the clinical COPD phenotypes, the circadian rhythm of COPD symptoms at baseline

Summary

Introduction

Chronic Obstructive Pulmonary Disease (COPD) encompasses various phenotypes that severely limit the applicability of precision respiratory medicine. Distinguishing the bronchitic from the emphysematous phenotype is apparently an easy task The former is marked by productive cough and early onset of hypoxemia, with high prevalence of respiratory failure and chronic cor pulmonale, whereas the latter displays early and severe dyspnea with late-onset hypoxemia. These clinical presentations could benefit selectively by the treatment options available, but, in real life settings the spectrum of therapies is variably distributed across the range of severity of COPD, without any distinction in terms of phenotypes, making such personalized care treatment more difficult

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