Prevalence and burden of breathlessness in Australian adults: The National Breathlessness Survey—a cross‐sectional web‐based population survey

Abstract

Background and objective: Chronic respiratory symptoms (in particular, breathlessness and cough) can cause physical, social and emotional distress, and may indicate the presence of an underlying disease that presages future poor health outcomes. Our aim was to investigate the burden of breathlessness in Australian adults, including breathlessness that may be undiagnosed, unlabelled or untreated. Methods: The National Breathlessness Survey was a cross-sectional, web-based survey conducted in October 2019. Australian adults were randomly selected from a large web-based survey panel with recruitment stratified by age-group, gender and state of residence according to national population data. The main outcome measures were modified Medical Research Council (mMRC) dyspnoea scale, EuroQol visual analog scale, Dyspnoea-12 score and 4-item Patient Health Questionnaire (PHQ-4). Results: Among all respondents (n = 10,072; 51.1% female; median age group 40-49 years), 9.5% reported clinically important breathlessness (mMRC dyspnoea grade ≥ 2, 2 = 'I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level'). Among those with clinically important breathlessness, 49.1% rated their general health as fair or poor and 44.2% had at least moderate depression or anxiety symptoms (PHQ ≥ 6) but over half (50.8%) did not report a current respiratory or heart condition diagnosis. Conclusion: Breathlessness is common among Australian adults, and is associated with a substantial burden of ill health, including among people without a diagnosed respiratory or heart condition. The extent of underdiagnosis of these conditions or alternative causes of breathlessness requires further investigation.

Underlying conditions contributing to breathlessness in the population

“…Of the included nine studies, eight were cross-sectional [ 21 , 22 ▪ , 23 ▪ , 24 , 25 , 26 – 28 ▪▪ ] and one was a longitudinal cohort study [ 29 ]. Breathlessness was measured using the modified Medical Research Council (mMRC) in eight of the nine studies [ 22 ▪ , 23 ▪ , 24 , 25 , 26 ▪ – 28 ▪▪ , 29 ]. The remaining study [ 21 ] used a yes/no question on having breathlessness ‘when hurrying or climbing the stairway’.…”

“…The remaining study [ 21 ] used a yes/no question on having breathlessness ‘when hurrying or climbing the stairway’. Breathlessness was defined as mMRC ≥1 in four studies [ 22 ▪ , 24 , 27 ▪ , 28 ▪▪ ] and as mMRC ≥2 [ 23 ▪ , 25 , 26 ▪ , 29 ] in the others. For the purpose of this review, presence of breathlessness was defined as mMRC ≥1 unless otherwise specified.…”

“…Underlying conditions were self-reported by the participants in all studies, but some studies obtained additional data from spirometry [ 24 , 25 , 27 ▪ , 28 ▪▪ , 29 ], echocardiography (ECG) [ 27 ▪ ] exercise testing [ 27 ▪ ] and weight and height measurements [ 27 ▪ , 28 ▪▪ ]. The largest study included 43 271 individuals [ 24 ], the second largest 13 437 [ 28 ▪▪ ], and the other seven studies had population samples of fewer than 10 000 individuals [ 21 , 25 , 26 ▪ , 29 ]. The smallest study had data on 1097 individuals [ 27 ▪ ].…”

“…The smallest study had data on 1097 individuals [ 27 ▪ ]. Slightly different age groups were studied, 50–64 years in three of the studies [ 27 ▪ , 28 ▪▪ , 29 ], older than 40 years in one study [ 25 ] and all adult age groups (>18 years) were included in five studies [ 21 , 22 ▪ , 23 ▪ , 24 , 26 ▪ ].…”

Health service utilisation associated with chronic breathlessness: random population sample

“…Chronic breathlessness is strongly associated with impairment of many aspects of personhood and wellbeing including prognosis [5], functional status [6], physical and mental domains of quality of life [7], activities of daily living including self-care [6] and sexual activity [8]. Depression and anxiety increase as chronic breathlessness worsens [6,9]. As daily breathlessness gets worse, people give up more and more activities in order to reduce provoking the symptom, limiting social interactions [10,11].…”