Do Patients With COPD Experience a Consistent Burden of Symptoms Over Time?

Mature adult man lying down on sofa in living room and using inhaler.He is wearing sleepwear
Does a patient’s COPD symptom burden change over time? Researchers examined this question, as well as characteristics of patients with more vs less COPD symptoms.

Patients with chronic obstructive pulmonary disease (COPD) tend to experience a consistent burden of symptoms over time, suggesting the importance of an individualized approach to symptom assessment and management. These were among study findings reported in Respiratory Medicine.

Researchers sought to ascertain whether patients with COPD experience consistent types and numbers of symptoms over time, as well as the characteristics associated with patients who experience a higher vs lower quantity and frequency of COPD symptoms.

The researchers conducted a longitudinal follow-up study of 267 adult patients diagnosed with moderate, severe, or very severe COPD. Patients were recruited from 1 referral hospital and 3 outpatient clinics in Norway. Researchers gathered information on clinical characteristics (health history, lung function, and comorbidities) HRQoL (using the St. George`s Respiratory Questionnaire) and symptoms (types and quantity, using the Memorial Symptom Assessment Scale). Specific symptoms of interest were shortness of breath, lack of energy, feeling drowsy, dry mouth, cough, worrying, pain, feeling bloated, difficulty sleeping, feeling sad, problems with sexual interest or activity, feeling nervous, feeling irritable, and difficulty concentrating.  

At baseline, patients were divided into 3 subgroups based on symptom occurrence rates: low, intermediate, and high. Patients were then reevaluated at months 3, 6, 9, and 12 to assess whether subgroup reclassification was warranted based on evaluation of clinical characteristics, symptoms, and HRQoL.

Researchers found that almost 65% of patients who were in the high group at baseline were still in the high group at 12 months. Likewise, no significant difference was noted in pairwise comparisons for respiratory function measurements at 12 months. In the low group, as many as 82% of patients remained in the low group after 12 months, and none were reclassified into the high group.

In assessing differences in patient characteristics between the 3 subgroups, the investigators found that participants in the high group were more likely to be women, had significantly more comorbidities, had significantly greater numbers of symptoms at all time points, and had worse HRQoL scores. Conversely, participants in the low group were more likely to be men, reported a significantly lower number of symptoms, and had fewer comorbidities.

In assessing most commonly occurring symptoms, the most common symptom reported in all 3 subgroups was shortness of breath. In the high and intermediate groups, lack of energy and pain were among the most commonly reported symptoms, whereas cough and dry mouth were among the top symptoms for patients in the low group.

Significant study limitations include unaccounted for common COPD-related symptoms (including wheezing, chest pain, and chest pressure); lack of generalizability to all COPD patients; selection bias; and non-response bias.

“Our findings suggest that the symptom burden in COPD patients continues over time,” concluded the researchers. “Multidimensional symptom assessments should be prioritized to better understand the patient’s experience with the burden of disease and provide the specific treatment needed,” keeping the primary focus of treatment on the patients’ individual symptom experience..  


Christensen VL, Rustøen T, Thoresen M, Holm AM, Bentsen SB. Stability of distinct symptom experiences in patients with chronic obstructive pulmonary disease (COPD). Respir Med. Published online August 8, 2022. doi:10.1016/j.rmed.2022.106944