Epidemiology of breathlessness – literature review · 32% mild dyspnoea (MRC 1 or 2) 23% severe dyspnoea (MRC >3) 37% moderate to severe dyspnoea (BDI interview) ! Breathlessness

Epidemiology of breathlessness – literature review

Breathlessness in the general population

Study Population study Study area Research design

Research method

Assessment of breathlessness

Epidemiology of breathlessness

Voll-Aanerud, 2008

General population sample (2,306 participants)

Sweden Part of a longitudinal cohort study

Survey

breathlessness defined as dyspnoea grade 2 (Are you breathless when you climb two flights of stairs at an ordinary pace?)

20,5% of women and 12% of men, giving an overall prevalence rate of 16.4%

Currow, 2009

5,473 participants over age 15 in South Australia (South Australian Health Omnibus) in 2006-200

Australia Cross sectional study

Survey

Self-reported breathlessness Modified MRC scale (1-5)

Overall prevalence 8.9% Prevalence of MRC 3-5 2.6% Prevalence by age groups 6.7% in individuals aged less than 35, 4.9% in individuals aged 35-49 9.8% in individuals aged 50-64 16.9% in individuals aged 65 or above

Bowden, 2011

5,331 participants aged 15 and over in South Australia (South Australian Health Omnibus) in 2007-2008

Australia Cross sectional study

Survey

Self-reported breathlessness Modified MRC scale (1-2-3-4)

Overall prevalence 11.1% Prevalence of MRC 2-4 3.4% Prevalence in people aged ≥50 years 15%

Figarska, 2012

population cohort of exclusively Caucasian individuals of Dutch descent. Of a total of 8,465 subjects, information on dyspnea was available for 7,360 subjects (87 %)

the Netherlands

Longitudinal cohort study

Dutch version of the UK MRC standard questionnaire

Never breathless except on strenuous exercise (dyspnea grade I), breathless when hurrying or walking up a slight hill (grade II), breathless while walking with other people of the same age on level ground (grade III), breathless after walking about 100 m or a few

Moderate dyspnoea (grade III and IV) 5% Severe dyspnoea (grade V and VI) 1%

Breathlessness in the general population

Study Population study Study area Research design

Research method



minutes on level ground (grade IV), breathless during everyday activities such as dressing or undressing (grade V), breathless at rest (grade VI). Severity of dyspnea: no dyspnea (grade I and II), moderate (III and IV) and severe (V and VI)

Breathlessness in primary care

Study Population study Study area

Research design

Research method



Jolly, 1978

121 patients (cases presenting with SoB + controls) in 1974-1975

Canada Cross sectional study

Medical charts review

Na

annual incidence 7.3 per 1,000 pts at risk per yr annual prevalence 15.4 per 1,000 pts at risk per yr

Kroenke, 1989

1,000 patients in primary care over a 3 year period (1984-1987)

USA Cross sectional study


Na 3.7/1,000 3-year incidence

Charles, 2005

602.100 encounters recorded by GPs in Australia from April 1998 to March2004

Australia

Cross sectional study


Na

5,215 encounters at which the patient gave SoB as one of their reasons for encounter, 0.9 per 100 encounters

Breathlessness among the elderly

Age group Study Population

study Study area Research design

Research method



45-69 Abramson, 2002

Random sample of 4,276 adults aged between 45 and 69 years drawn from electoral rolls

Melbourne, Victoria, Australia


Survey Self reported SoB Measured by MRC scale

Overall prevalence 27.2% 37.9% breathless when walking with people their own age 18.4% breathless when walking at own pace 16.2% breathless at rest

> 55 Boezen, 1998

Random sample of 210 subjects (> 55 years old) who participated in a physical

The Netherlands


Survey Borg score > 0 Prevalence 24%

Breathlessness among the elderly

Age group Study Population

study Study area Research design

Research method



fitness test

60-79 Pedersen, 2007

152 examined pts with SoB grade > 1 and age 60-79 living at home

Na


Survey + clinical examination

MRC > 1 31% with SoB confirmed at examination

65 ad over

Barberger-Gateau (1992)

2,792 community residents aged 65 and over

France


Interviews

4 level scale Do you feel out of breath in some of the following circumstances: at rest, in performing ctivities of daily living, for minor efforts (walking at same pace of people same age), for major efforts (climbing more than one flight of stairs, never)

Overall 61.6% 63.8% women 58.3% men

70 and over

Ho, 2001

1,169 subjects from GP lists, aged 70 and over living at home in Wales

Wales, UK


Survey + Clinical assessment

MRC Clinically significant breathlessness for MRC grades 3-5

32.3% with SoB confirmed at clinical assessment

70 and over

Huijnen, 2006

From the population of elderly patients in a family practice health center, 114 were randomly selected

The Netherlands

Cohort study

questionnaire, supplemented with an interview

MRC Scale and BDI MRC 1 or 2 mild MRC > 3 moderate to severe

55% MRC >1 32% mild dyspnoea (MRC 1 or 2) 23% severe dyspnoea (MRC >3) 37% moderate to severe dyspnoea (BDI interview)

Breathlessness among end-of-life patients

Underlying condition Study Population

study Study area

Research design

Research method



Cancer Thomas, 2011 Na Na Na Na Na 50-70%

CHF Solano, 2006 Na Na Systematic

review Na na 88%

COPD Solano, 2006 Na Na Systematic

review Na na 95%

Lung cancer 78%

COPD

Edmonds, 2001

Random sample of deaths of adults, 449 deaths related to lung cancer and 87 related to COPD

England Cross sectional study

Interviews with relatives

Na

94%

Breathlessness in A&E

Study Population study Study area

Research design

Research method



Pearson, 1981

All patients admitted as medical emergencies during a summer period (352) and during the winter months (355)

UK Cross sectional study


Acute breathlessness

25% of all patients admitted as medical emergencies and treated for breathlessness

Fedullo, 1986

All patients seen in A&E for a 5-week period (6,005 patients in total)

USA Cross sectional study

Medical chart review

Acute breathlessness 2.7% of all A&E visits

Mustchin, 1982

About 370 emergency admission to a district general hospital during a 53 days period in 1981

USA Prospective survey

Medical chart review

na 21% of all A&E admissions

IMPRESS Breathlessness Working Party and London School of Economics and Political Science Department of Management supported by the Health Foundation

Downloadable from http://www.impressresp.com/index.php?option=com_docman&Itemid=82 or contact

Siân Williams [email protected]

January 2014

References Abramson M, Matheson M, Wharton C, Sim M, Walters EH. Prevalence of respiratory symptoms related to chronic obstructive pulmonary disease and asthma among middle aged and older adults. Respirology. 2002;7(4):325–31.

Barberger-Gateau P, Chaslerie A, Dartigues JF, Commenges D, Gagnon M, Salamon R. Health measures correlates in a French elderly community population: the PAQUID study. J Gerontol. 1992 Mar;47(2):S88-95.

Boezen HM, Rijcken B, Schouten JP, Postma D S. Breathlessness in elderly individuals is related to low lung function and reversibility of airway obstruction. European Respiratory Journal. 1998;12(4):805–810.

Bowden J, To THM, Abernethy AP, Currow DC. Predictors of chronic breathlessness: a large population study. BMC public health. 2011;11(1):33.

Charles J, Ng A, Britt H. Presentations of shortness of breath in Australian general practice. Australian family physician. 2005;34(7):520–1.

Currow DC, Plummer JL, Crockett A, Abernethy AP. A community population survey of prevalence and severity of dyspnea in adults. Journal of pain and symptom management. 2009;38(4):533–45.

Edmonds P, Karlsen S, Khan S, Addington-Hall J. A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer. Palliat Med. 2001 Jul;15(4):287-95.

Fedullo AJ, Swinburne AJ, McGuire-Dunn C. Complaints of breathlessness in the emergency department. The experience at a community hospital. N Y State J Med. 1986 Jan;86(1):4-6.

Figarska SM, Boezen HM, Vonk JM. Dyspnea severity, changes in dyspnea status and mortality in the general population: the Vlagtwedde/Vlaardingen study. Eur J Epidemiol. 2012 Nov;27(11):867-76.

Ho SF, O’Mahony MS, Steward JA, Breay P, Buchalter M, Burr ML. Dysponea and quality of life in older people at home. Age Ageing. 2001 Mar;30(2):155-9.

Huijnen B, van der Horst F, van Amelsvoort L, Wesseling G, Lansbergen M, Aarts P, Nicolson N, Knottnerus A. Dyspnea in elderly family practice patients. Occurrence, severity, quality of life and mortality over an 8-year period. Fam Pract. 2006 Feb;23(1):34-9.

Jolly DT. Dyspnea in Primary Care. Can.Fam.Physician. 1978;24:983–988.

Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. The American journal of medicine. 1989;86(3):262–6.

Mustchin CP, Tiwari I. Diagnosing the breathless patient. Lancet. 1982 Apr 17;1(8277):907-8.

Pearson SB. The diagnosis and management of patients admitted to hospital with acute breathlessness. Postgraduate medical journal. 1981;57(669):419.

Pedersen F, Mehlsen J, Raymond I, Atar D, Skjoldborg US, Hildebrandt PR. Evaluation of dyspnoea in a sample of elderly subjects recruited from general practice. International journal of clinical practice. 2007;61(9):1481–91.

Solano JP, Gomez B, Higginson IJ: A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease (COPD), and renal disease. J Pain Symptom Management. 2006;31(1):58-69.

Thomas S, Bausewein C, Higginson I, Booth S. Breathlessness in cancer patients - implications, management and challenges. Eur J Oncol Nurs. 2011 Dec;15(5):459-69.

Voll-Aanerud M, Eagan TM, Wentzel-Larsen T, Gulsvik A, Bakke PS. Respiratory symptoms, COPD severity, and health related quality of life in a general population sample. Respir Med. 2008 Mar;102(3):399-406.

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Epidemiology of breathlessness – literature review · 32% mild dyspnoea (MRC 1 or 2) 23% severe dyspnoea (MRC >3) 37% moderate to severe dyspnoea (BDI interview) ! Breathlessness