Breathlessness Related to Medical Conditions in Middle-Aged Adults: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in the journal Respiratory Research that examined the burden of breathlessness related to different medical conditions in middle-aged adults.

The study

Investigators conducted a population-based, cross-sectional analysis of the Swedish CArdioPulmonary bioImage Study (SCAPIS), which enrolled individuals aged 50 to 64 years from 2013 to 2018 at 6 study centers. They also evaluated breathlessness in clinically relevant subgroups by sex, smoking history, and presence or absence of self-reported cardiorespiratory disease.

For the purpose of the study, breathlessness was defined as a self-rated modified Medical Research Council (mMRC) score of at least 2 and was evaluated in relation to various self-reported medical conditions (reported by patients as being physician diagnosed). The analysis also included self-reported data on demographics, smoking history, pack-years of smoking, education, type of residence, stress, depression, and exercise level.

The analysis also included patient data regarding body mass index (BMI), postbronchodilator spirometry forced expiratory volume in 1 second, forced vital capacity, pulmonary emphysema, chronic airflow limitation, coronary artery calcifications, and coronary artery stenosis. Population attributable fractions (PAFs) were calculated based on the prevalence of each condition and its adjusted odds ratio (aOR).

The analysis included 25 948 individuals, with a mean age of 57.5 years and mean BMI of 26.9 kg/m². Among the cohort, 51% were women, 37% were former smokers, 12% were current smokers, 43% were overweight, 21% were obese. Also, among the cohort, 25% had respiratory disease, 14% had depression, 9% had cardiac disease, and 3% had anemia.

The findings

Results showed that breathlessness (mMRC ≥2) was present in 3.7% (n=952) of participants.

Individuals with breathlessness compared to those without breathlessness had an increased prevalence of obesity (56% vs 19%), respiratory disease (49% vs 24%), stress (41% vs 20% reporting constant stress for 1 year or longer), depression (37% vs 13%), cardiac disease (19% vs 9%), and anemia (5% vs 3%) (P < .001 for all comparisons).

Medical conditions with the highest PAFs for breathlessness were overweight and obesity (62.9%; 95% CI 59.6%-66.0%), stress (60.2%; 95% CI 31.6%-76.8%), respiratory disease (29.1%; 95% CI 20.1%-37.1%), depression (22%; 95% CI 17.1%-26.6%), cardiac disease (9.5%; 95% CI 6.3%-12.7%), and anemia (2.0%; 95% CI 0.8%-3.3%).

Authors' comment

"This study provides novel data on the most common underlying medical conditions to consider in the clinical evaluation of people with breathlessness, and given the population-based design, the findings may pertain particularly to people evaluated in primary care."

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