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A cross-sectional observational study to investigate daily symptom variability, effects of symptom on morning activities and therapeutic expectations of patients and physicians in COPD-SUNRISE study

A cross-sectional observational study to investigate daily symptom variability,
effects of symptom on morning activities and therapeutic expectations
of patients and physicians in COPD-SUNRISE study

Tülin KuyucU1, Salih Zeki Güçlü2, Bengü Şaylan3, Cahit Demİr4, Tuncer Şenol5, Serdar Güner6,
Ejder Koyuncu7, Ferit Özen8, Sezai Öztürk9, Zeki Cangül10, Semih AĞanoĞlu11, Şevket Özkaya12,
Sevilay Çiçek Ocak13, Hüseyin Akkurt14, Yavuz Selim İntepe15, Merve Gülcan Bayrak16,
Tuncay Güler17, Taha Tahir Bekçİ18, Şadan SoyyİĞİt19, Salim Seyfettİn20, Özhan Kula21,
Makbule Özlem Akbay22, Bengü BÜYÜKGÖZE23, Gökhan Asal24, Şeyma BaŞlIlar3, Osman Öztürk25
(Turkey SUNRISE Study Group; sites are listed in order of number of patients included).

1 Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey,

2 Private Office, Izmir, Turkey,

3 Umraniye Training and Research Hospital, Istanbul, Turkey,

4 Private Vizyon Physical Therapy and Rehabilitation Center, Ankara, Turkey,

5 Private Office, Sanliurfa, Turkey,

6 Turgutlu Government Hospital, Turgutlu, Manisa, Turkey,

7 Soke Fehime Kocagoz Government Hospital, Soke, Aydin, Turkey,

8 Private Office, Denizli, Turkey,

9 Istanbul Chest Diseases Center, Istanbul, Turkey,

10 Private Office, Istanbul, Turkey,

11 Rize Sar Hospital, Rize, Turkey,

12 Rize Training and Research Hospital, Rize, Turkey,

13 Esenyurt Government Hospital, Istanbul, Turkey,

14 Private Office, Ankara, Turkey,

15 Yozgat Government Hospital, Yozgat, Turkey,

16 Carsamba Government Hospital, Carsamba, Ordu, Turkey,

17 Bolu Izzet Baysal Government Hospital, Bolu, Turkey,

18 Konya Training and Research Hospital, Konya, Turkey,

19 Mustafa Yazici Chest Diseases Hospital, Aksaray, Turkey,

20 Private Office, Antakya, Turkey,

21 Private Office, Bursa, Turkey,

22 Bilecik Bozoyuk Government Hospital, Bozoyuk, Bilecik, Turkey,

23 Private Office, Kocaeli, Turkey,

24 Antalya Private Yildiz Andeva Hospital, Antalya, Turkey,

25 Nallihan Government Hospital, Nallihan, Ankara, Turkey.


Chronic obstructive pulmonary disease (COPD) is a lung disease characterized with limitation of airflow that is not completely reversible, progressive deterioration of airways and systemic inflammation. This study has been planned to determine daily symptom variability of patients, expectations of patient and physicians from treatment and patient profiles. A total of 514 patients with COPD from 25 centers were included in this national, multicenter, cross-sectional observational study. Data regarding demographic features, concomitant diseases, history and treatment of COPD and expectations of patients and physicians were all obtained in a single visit. Mean [standard deviation (SD)] age of the patients was 64.1 (9.5) years; age range was 41-92 years, 50% of the patients were younger than 65 years and 91% were males. Educational level of the patients was at least primary school in 80.2%; and 54.3% (30.4%) of the patients had at least one concomitant disease, particularly a cardiovascular disease. Mean (SD) duration of having COPD was 5.4 (4.6) years. The majority of patients were at moderate (43.2%) and severe (35.0%) COPD stages and one or more exacerbations per year was determined in 71%. Inhaled beta-2 agonists (84.2%), inhaled steroids (76.3%) and inhaled long-acting anti-cholinergics (70.0%) were the most commonly used medications. Dyspnea (99.0%), sputum production (92.8%) and wheezing (90.5%) were the most common symptoms, and symptom variability for dyspnea (41.1%), sputum production (61.0%) and cough (53.5%) were seen the most in the morning hours (p< 0.001). Most commonly affected morning activity was climbing up/down the stairs (point of effect: 6.7), followed by wearing socks/shoes (point of effect: 4.3) and showering/bathing (point of effect: 4.2) by COPD. Major treatment expectations of patients were greater symptomatic relief (82.3%) and greater mobility (70.0%), faster symptomatic relief (61.1%) and improvement in morning activities (59.3%); while major treatment expectations of physicians included increased quality of life (100.0%) and decreased morbidity (96.0%). Quitting smoking was the most commonly recommended (88.3%) and implemented (67.9%) non-drug protective approach aimed at decreasing the frequency of exacerbations. Consequently, our results demonstrate that COPD is not a disease of only the elderly, is an important healthcare issue that often disrupt daily living of the patients due to inadequate disease awareness leading to overlooking of the symptoms by patient and physicians, and that a patient-centered approach based on the living standards, life expectancies and preferences of patients was crucial in patient management.

Key Words: COPD, symptoms, patient profile, therapeutic expectations.

Address for Correspondence:

Dr. Tülin Kuyucu,

SB Süreyyapaşa Göğüs Hastalıkları ve

Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi,

2. Göğüs Hastalıkları Kliniği,

Başıbüyük Mahallesi

34844 Maltepe İSTANBUL - TURKEY

e-mail: tnkuyucu@yahoo.com

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