Background: We explored if night and morning symptoms give additional information in the management of COPD.Method: We included data from 2,269 primary COPD patients (58% male, 49% smokers, mean age 65±11 years) who were referred for diagnostic assessment to an Asthma/COPD service. Spirometry, patient history, the Clinical COPD Questionnaire(CCQ) and the Asthma Control Questionnaire(ACQ) were part of the regular assessment procedure. The ACQ was used to evaluate night (question 1) and morning symptoms (question 2). We selected patients with low CCQ scores(<2) and evaluated within this group the number of patients with many night and morning symptoms. Patient characteristics of patients with many night and morning symptoms were compared with other patients using chi square and Kruskal-Wallis test. Finally, regression was used to examine to what extend an increase in symptoms was associated with health status.Results: 879 (39%) patients had night complaints(ACQ 1>0) and 1159 (53%) patients reported morning symptoms(ACQ 2>0). A subset of patients had severe symptoms(ACQ 1³4, n=74, 3% and ACQ 2³4, n=109, 5%). Only a small proportion of the low symptomatic patients(CCQ<2) had severe night(ACQ 1³4 n=11, 1%) or morning symptoms (ACQ 2³4, n=19, 2.0%. And increase in ACQ 1 or ACQ 2 score decreased health status even if we took into account baseline health status (Morning symptoms: B=0.5, p<0.00|night symptoms: B=0.3, p=0.01).Conclusion: Night and morning symptoms were common in COPD patients, they seem to go along with other COPD symptoms and are associated with a decrease in health status.