Nighttime Symptom Burden in Chronic Obstructive Pulmonary Disease: A Qualitative Study

Nighttime symptoms are clinically important but understudied in chronic obstructive pulmonary disease (COPD). This study explored patients' perceptions of nighttime symptoms, their effects on daily life, and symptom-management strategies.

Thirty U.S. adults with COPD and moderate-to-high symptom burden (COPD Assessment Test score ≥10), without hospitalization or emergency department visits for severe exacerbation during the previous year, participated in semi-structured interviews. All participants received single-inhaler dual or triple maintenance therapy and completed the 7-item COPD and Asthma Sleep Impact Scal. Interviews were transcribed verbatim and thematically analyzed using the Symptom Management Theory framework.

Participants (median age 63; 60% female; 90% White) reported a high burden of nighttime symptoms and sleep disruption (87% severely impacted based on CASIS). Participants described a pronounced nighttime symptom experience, most frequently shortness of breath, mucus/phlegm production, coughing, and difficulty staying asleep or frequent awakenings. A range of symptom management strategies was reported, including behavioral adaptations (routines, avoidance of technology, sleep hygiene), pharmacological management (antidepressants, sleep medications, rescue inhalers), and complementary and integrative approaches (meditation, acupuncture, relaxation techniques). Nighttime symptom outcomes extended beyond sleep disruption. Participants reported significant daytime consequences, including fatigue and impaired concentration. These effects contributed to activity avoidance and limitations in social participation.

Among symptomatic patients receiving single-inhaler dual or triple maintenance therapy, nighttime COPD symptoms were commonly reported and were associated with substantial physical, emotional, and functional impacts. The findings support further consideration of nighttime symptoms in clinical assessment and individualized COPD management.