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Introduction
Nighttime symptoms are common in patients with stable COPD, although they have not been well defined, they are probably underreported and/or underestimated, and their physiopathology is not entirely clear.1-3 Nighttime symptoms, and dyspnea in particular, are associated with more severe disease as measured by FEV1,4 although the association is weak in some reports.5 The presence of nocturnal dyspnea in patients with stable COPD is associated with significant outcomes, such as an increased risk of future exacerbations and death.4 There are several potential mechanisms for nighttime symptoms in COPD, and it is plausible that they could be associated with effects such as worsening hypoxia or hypercapnia, or arrythmias, which could increase mortality risk, particularly during exacerbations.6 However, there is a lack of studies evaluating the real clinical impact of nocturnal dyspnea during exacerbations.
The hypothesis of the present study was that nocturnal dyspnea during severe exacerbations of COPD would be associated with an increased risk of short-term mortality. The objective of the study was to verify if this symptom is associated with said risk, independently of other variables of severity of the disease or of the exacerbation itself.
Methods
This was a non-interventional historical cohort study conducted in the Respiratory Department of a second-level university hospital. Eligible subjects were all consecutive patients seen in the dedicated COPD unit between 2008–2017. The index date was the date of the first visit to the morning clinic of the COPD unit. We reasoned that, after said visit, the baseline treatment should be reasonably optimized, reducing a source of variability for subsequent clinical evolution. The inclusion criteria were a diagnosis of COPD according to the Global Initiative for Chronic Obstructive Lung Disease COPD report7 and having suffered at least one severe exacerbation that required hospital admission …
Correspondence: Rafael Golpe PhD, Servicio de Neumología, Unidad Administrativa 4-A, Hospital Universitario Lucus Augusti, C/Dr Ulises Romero, 1. 27002 Lugo, Spain. E-mail: rafael.golpe.gomez{at}sergas.es
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