The Relationship Between 24-Hour Symptoms and COPD Exacerbations and Healthcare Resource Use: Results from an Observational Study (ASSESS)

Research output: Contribution to journalArticle


This observational study assessed the relationship between nighttime, early-morning and daytime chronic obstructive pulmonary disease (COPD) symptoms and exacerbations and healthcare resource use. COPD symptoms were assessed at baseline in patients with stable COPD using a standardised questionnaire during routine clinical visits. Information was recorded on exacerbations and healthcare resource use during the year before baseline and during a 6-month follow-up period. The main objective of the analysis was to determine the predictive nature of current symptoms for future exacerbations and healthcare resource use. 727 patients were eligible (65.8% male, mean age: 67.2 years, % predicted forced expiratory volume in 1 second: 52.8%); 698 patients (96.0%) provided information after 6 months. Symptoms in any part of the day were associated with a prior history of exacerbations (all p <0.05) and nighttime and early-morning symptoms were associated with the frequency of primary care visits in the year before baseline (both p <0.01). During follow-up, patients with baseline symptoms during any part of the 24-hour day had more exacerbations than patients with no symptoms in each period (all p <0.05); there was also an association between 24-hour symptoms and the frequency of primary care visits (all p ≤ 0.01). Although there was a significant association between early-morning and daytime symptoms and exacerbations during follow-up (both p <0.01), significance was not maintained when adjusted for potential confounders. Prior exacerbations were most strongly associated with future risk of exacerbation. The results suggest 24-hour COPD symptoms do not independently predict future exacerbation risk.


  • Marc Miravitlles
  • Heinrich Worth
  • Juan José Soler-Cataluña
  • David Price
  • Fernando De Benedetto
  • Nicolas Roche
  • Nina S. Godtfredsen
  • Thys van der Molen
  • Claes Göran Löfdahl
  • Laura Padullés
  • Anna Ribera
External organisations
  • Vall d'Hebron University Hospital
  • Facharztforum Fürth
  • Hospital Arnau de Vilanova
  • University of Aberdeen
  • University of Chieti-Pescara
  • Paris Descartes University
  • Hvidovre Hospital
  • University of Groningen
  • Laboratorios Almirall
  • AstraZeneca, Sweden
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Respiratory Medicine and Allergy


  • Cohort, exacerbation risk, morning symptoms, nighttime symptoms, prospective, retrospective, COPD
Original languageEnglish
Pages (from-to)561-568
Number of pages8
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
Issue number5
Publication statusPublished - 2016 Sep
Publication categoryResearch