Impact of Dyspnea on Adults With Respiratory Symptoms Without a Defined Diagnosis

• DOI: 10.1016/j.chest.2024.07.183
• Publication Date: 2024-09-04T06:21:56Z
• Authors: Jared Bierbrier; Emily Gerstein; George A. Whitmore; Katherine L. Vand...; Celine Bergeron; Louis-Philippe Bo...; Andreanne Cote; Stephen K. Field; Erika Penz; R. Andrew McIvor; Catherine Lemière; Samir Gupta; Paul Hernandez; Irvin Mayers; Mohit Bhutani; M. Diane Lougheed; Christopher J. Li...; Tanweer Azher; Nicole Ezer; Martha Ainslie; Gonzalo G. Alvarez; Sunita Mulpuru; Shawn D. Aaron

We investigated dyspnea, its associated risk factors, and its impact on health care utilization, quality of life, and work productivity in adults with undiagnosed respiratory symptoms.What is the impact of dyspnea in adults with undiagnosed respiratory symptoms?This population-based study included 2,857 adults who were experiencing respiratory symptoms. These individuals had not been previously diagnosed with any lung conditions and were recruited from 17 Canadian centers using random digit dialing. Each participant underwent spirometry testing both before and after using a bronchodilator to determine if they met the diagnostic criteria for COPD, asthma, or preserved ratio impaired spirometry (PRISm), or if their spirometry results were normal. An age-matched control group (n = 231) was similarly recruited using random digit dialing. A dyspnea impact assessment score from 0 to 100 was produced using questions from the COPD Assessment Test and St. George's Respiratory questionnaire.Individuals with PRISm (n = 172) reported more impactful dyspnea (mean score, 63.0; 95% CI, 59.5-66.4) than those with undiagnosed asthma (n = 265; mean score, 56.6; 95% CI, 53.9-59.3) or undiagnosed COPD (n = 330; mean score, 57.5; 95% CI, 55.1-59.9). All groups reported significantly more impactful dyspnea than the control group (mean score, 13.8; 95% CI, 11.8-15.7). Patient-specific risk factors including age, sex, BMI, smoking, and comorbidities explained 20.6% of the variation in dyspnea. An additional 12.4% of the variation was explained by disease classification and another 1.7% by the severity of lung function impairment assessed with spirometry. After adjusting for age, sex, and BMI, greater dyspnea impact was associated with increased health care utilization, lower quality of life, and reduced work productivity.In community-based adults with undiagnosed respiratory symptoms, those identified with PRISm experienced the greatest impact of dyspnea. Dyspnea imposes burdens on the health care system and is associated with impaired quality of life and work productivity.