Morning symptoms are common among patients with chronic obstructive pulmonary disease (COPD) and are frequently associated with limitations of physical activity, according to a study published in the European Respiratory Review.

Amanda R van Buul, from the Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands, and colleagues conducted a systematic review to examine the association between morning symptoms and physical activity. Eight studies were included in the review.

The rate of patients with morning symptoms ranged from 39.8% to 94.4% in the studies. Among all patients with COPD, 37% to 90.6% of patients experienced physical activity limitations that were associated with morning symptoms.

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The most common limited activities that were reported included getting up, taking a shower, and dressing. Shortness of breath was the symptom that was most strongly associated with reduced ability to perform tasks, and about half of participants reported making changes to their morning routine because of morning symptoms.

The researchers found that morning symptoms were associated with a sedentary lifestyle and treatment in accordance with guidelines improved the degree of activity limitations due to morning symptoms.

The association between morning symptoms and physical activity suggests that clinicians should include the evaluation of morning symptoms in their clinical assessment. In addition, the researchers reported that 79% of patients with COPD felt relief from morning symptoms with medication, which suggests that controlling morning symptoms should also be a goal of treatment.

“Future studies, preferably prospective randomized trials, should focus on objectively measured physical activity in COPD patients especially in the morning,” the study authors wrote. “We also recommend validation of a tool to evaluate morning symptoms, because a validated tool is lacking. If more evidence supports the finding that morning symptoms and physical activity are related, these factors will be more emphasized and will find a place in guidelines and statements.”


  1. Van Buul AR, Kasteleyn MJ, Chavannes NH, Taube C. Association between morning symptoms and physical activity in COPD: A systematic review. Eur Respir Rev. 2017. doi:10.1183/16000617.0033-2016