What question did this study set out to answer?

Characterize patient perceptions of nighttime symptoms and their impacts on life in COPD.

May 20, 2026

B102-21 Patient Perspectives on Nighttime Symptoms Associated With Chronic Obstructive Pulmonary Disease (Pneumos): A Qualitative Study

Key Points

Characterize patient perceptions of nighttime symptoms and their impacts on life in COPD.
Qualitative study recruiting 30 U.S. adults with moderate to severe COPD symptoms, no recent hospitalizations.
Participants completed a sleep impact assessment and underwent semi-structured interviews.
Data analyzed using content analysis in Atlas.ti and R for code frequency.
87% of participants reported severe impact on sleep based on the CASIS scale.
Common nighttime symptoms included shortness of breath (80%), mucus production (80%), and frequent awakenings (77%).
Participants reported various self-management strategies, including sleep routines (33%) and relaxation techniques (33%).

Abstract

Abstract Rationale Nighttime symptoms are a clinically significant, yet understudied aspect of chronic obstructive pulmonary disease (COPD). This study aimed to characterize patients’ perceptions and the impact of nighttime COPD symptoms on their lives, and describe self-management strategies used to manage around-the-clock symptoms. Methods This qualitative study recruited 30 U.S. adults with COPD who experienced moderate or high symptom burden (COPD Assessment Test CAT score ≥10), with no COPD hospitalizations in the past year. All participants were on single-inhaler dual or triple maintenance therapy. Participants completed the 7-item COPD and Asthma Sleep Impact Assessment Scale (CASIS) questionnaire. Semi-structured interviews were transcribed and analysed using content analysis techniques in Atlas.ti version 25, with code frequency tabulated in R version 4.3. Results Participants (median age 63; 60% female; 90% White) reported a high burden of nighttime symptoms and sleep disruption (87% severely impacted based on CASIS). The most frequently mentioned nighttime symptoms were shortness of breath (80%), mucus/phlegm production (80%), coughing (77%), and difficulty staying asleep or frequent awakenings (77%). Example quotes from the participants are in the Table. Nighttime symptoms had associated physical (93%), emotional (77%), cognitive (63%), and social (60%) impacts. Participants reported various strategies to self-manage nighttime COPD symptoms. Non-pharmaceutical approaches included sticking to sleep routines (33%) and relaxation techniques (33%). Thirty percent of participants reported using non-COPD medications, mainly antidepressants, to aid sleep. Forty-four percent used rescue inhalers before bedtime to prevent symptoms, and one reported using their once-daily maintenance inhaler at night. Among those with experience using twice-daily regimens (n = 24/30, 80%), some noted improved nighttime symptom control (6/24), better sleep (5/24), and longer relief (5/24). Conclusions Patients with COPD experience a substantial burden of nighttime symptoms that contributed to impaired sleep and reduced daily functioning. Participants applied various self-management sleeping strategies, and some patients perceived better relief with twice-daily triple therapy regimens. Clinicians should systematically assess and address nighttime symptoms as part of routine COPD management. Tailored educational efforts and treatment strategies should address individual nighttime symptom patterns. This abstract is funded by: AstraZeneca

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