epidemiology of breathlessness – literature review · 32% mild dyspnoea (mrc 1 or 2) 23% severe...
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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
Assessment of breathlessness
Epidemiology of breathlessness
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
Assessment of breathlessness
Epidemiology of breathlessness
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
Medical charts review
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
Medical charts review
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
Assessment of breathlessness
Epidemiology of breathlessness
45-69 Abramson, 2002
Random sample of 4,276 adults aged between 45 and 69 years drawn from electoral rolls
Melbourne, Victoria, Australia
Cross sectional study
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
Cross sectional study
Survey Borg score > 0 Prevalence 24%
Breathlessness among the elderly
Age group Study Population
study Study area Research design
Research method
Assessment of breathlessness
Epidemiology of breathlessness
fitness test
60-79 Pedersen, 2007
152 examined pts with SoB grade > 1 and age 60-79 living at home
Na
Cross sectional study
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
Cross sectional study
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
Cross sectional study
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
Assessment of breathlessness
Epidemiology of breathlessness
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
Assessment of breathlessness
Epidemiology of breathlessness
Pearson, 1981
All patients admitted as medical emergencies during a summer period (352) and during the winter months (355)
UK Cross sectional study
Medical charts review
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
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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.
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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.