COPD: Symptom Frequency and Severity

Symptom Frequency and Severity

Although COPD symptoms are more chronic than episodic, patients may have acute changes, and the severity of symptoms may vary during the year. Hence, patients surveyed were asked about the frequency of their symptoms during their worst three-month period in the past year (Figure 6). During that time period:

79% had been short of breath at least a few days a week; 58% had shortness of breath every day.

76% had coughed at least a few days a week; 53% had coughed every day.

72% had brought up phlegm at least a few days a week; 48% had brought up phlegm every day.

49% had awakened at night due to coughing, wheezing, or shortness of breath at least a few days a week; 23% had been awakened by these symptoms every night.

The vast majority of people diagnosed with COPD (90%) said they had one or more COPD symptoms either every day or most days during their worst three-month period in the past year. Surprisingly, the same percentage of people with undiagnosed COPD (91%) also reported one or more of these symptoms every day or most days (Figure 7).

Impact of Breathlessness on Activities
The impact of breathlessness on everyday activities was striking (Figure 8):

28% had difficulty breathing even when sitting or lying still.
32% got short of breath when talking.
44% got short of breath when washing or dressing.
46% got short of breath when doing light housework.
72% felt breathless when walking up one flight of stairs.

Patients were asked to rate their condition according to the Medical Research Council (MRC) five-point breathlessness scale (Figure 9):⁴

25% got breathless when hurrying on level ground or walking up a slight incline; 15% got breathless after strenuous exercise— the mildest degree of dyspnea.
10% walked slower than most people their age.
7% got breathless even when walking at their own pace.
32% had to stop for breath after walking a few minutes.
8% were too breathless to leave the house— the most severe level of dyspnea.

Despite this level of functional impairment, not even a quarter (23%) of patients with COPD described their condition as "severe." Thirty-eight percent described their COPD as "moderate," and another third (34%) described their condition as "mild" (Figure 10).

Indeed, there was a significant disparity between patient perceptions of their disease severity and the degree of severity indicated by the MRC breathlessness scale. A surprising 36% of people with the most severe degree of breathlessness described their condition as "mild" or "moderate" (Figure 11).

Symptom Severity and Age
The survey findings corroborated the clinical observation that COPD tends to get worse as patients get older: use of home oxygen therapy, an indicator of disease severity, increased from 8% among 45-54 year olds to 33% among patients 75 and older (Figure 12).

Yet surprisingly, younger patients reported more severe and frequent symptoms than did older patients. One possible explanation for this finding— older patients, not younger patients, should be reporting more severe and frequent symptoms— is that younger patients were more acutely aware of their symptoms. Older patients may have grown so accustomed to living with COPD that they tended to underreport their symptoms and adjusted their lifestyles in order to minimize the occurrence of symptoms.