Figure 1 (A) Mean symptom scores taken from diary cards for a study group of 468 patients. Around the first protocol defined exacerbation, patients are experiencing appropriate symptoms when they attend their doctor (•, shortness of breath; ▪, cough; ♦, chest tightness; ▴, night time awakening; day 0, first day of exacerbations). (B) In individual patients there is a much weaker relationship between symptom change and medical contact whether the symptoms are viewed singularly or in combination. Reproduced with permission from Calverley et al.¹⁹