Skip to main content
Top
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Predictors of chronic breathlessness: a large population study

Authors: Jacqueline A Bowden, Timothy HM To, Amy P Abernethy, David C Currow

Published in: BMC Public Health | Issue 1/2011

Login to get access

Abstract

Background

Breathlessness causes significant burden in our community but the underlying socio-demographic and lifestyle factors that may influence it are not well quantified. This study aims to define these predictors of chronic breathlessness at a population level.

Methods

Data were collected from adult South Australians in 2007 and 2008 (n = 5331) as part of a face-to-face, cross-sectional, whole-of-population, multi-stage, systematic area sampling population health survey. The main outcome variable was breathlessness in logistic regression models. Lifestyle factors examined included smoking history, smoke-free housing, level of physical activity and body mass index (obesity).

Results

The participation rate was 64.1%, and 11.1% of individuals (15.0% if aged ≥50 years) chronically had breathlessness that limited exertion. Significant bivariate associations with chronic breathlessness for the whole population and only those ≥50 included: increasing age; female gender; being separated/divorced/widowed; social disadvantage; smoking status; those without a smoke-free home; low levels of physical activity; and obesity. In multi-variate analyses adjusted for age, marital status (p < 0.001), physical activity (p < 0.001), obesity (p < 0.001), gender (p < 0.05) and social disadvantage (p < 0.05) remained significant factors. Smoking history was not a significant contributor to the model.

Conclusions

There is potential benefit in addressing reversible lifestyle causes of breathlessness including high body mass index (obesity) and low levels of physical activity in order to decrease the prevalence of chronic breathlessness. Clinical intervention studies for chronic breathlessness should consider stratification by body mass index.
Appendix
Available only for authorised users
Literature
1.
go back to reference Charles J, Ng A, Britt H: Presentations of shortness of breath in Australian general practice. Aust Fam Physician. 2005, 34 (7): 520-521.PubMed Charles J, Ng A, Britt H: Presentations of shortness of breath in Australian general practice. Aust Fam Physician. 2005, 34 (7): 520-521.PubMed
2.
go back to reference Mahler DA, Selecky PA, Harrod CG, Benditt JO, Carrieri-Kohlman V, Curtis JR, Manning HL, Mularski RA, Varkey B, Campbell M, Carter ER, Chiong JR, Ely EW, Hansen-Flaschen J, O'Donnell DE, Waller A: American College of Chest Physicians consensus statement on the management of dyspnoea in patients with advanced lung or heart disease. Chest. 2010, 137 (3): 674-91. 10.1378/chest.09-1543.CrossRefPubMed Mahler DA, Selecky PA, Harrod CG, Benditt JO, Carrieri-Kohlman V, Curtis JR, Manning HL, Mularski RA, Varkey B, Campbell M, Carter ER, Chiong JR, Ely EW, Hansen-Flaschen J, O'Donnell DE, Waller A: American College of Chest Physicians consensus statement on the management of dyspnoea in patients with advanced lung or heart disease. Chest. 2010, 137 (3): 674-91. 10.1378/chest.09-1543.CrossRefPubMed
3.
go back to reference O'Donnell DE, Banzett RB, Carrieri-Kohlman V, Casaburi R, Davenport PW, Gandevia SC, Gelb AF, Mahler DA, Webb KA: Pathophysiology of dyspnoea in COPD. Proc Am Thorac Soc. 2007, 4: 145-168.CrossRefPubMed O'Donnell DE, Banzett RB, Carrieri-Kohlman V, Casaburi R, Davenport PW, Gandevia SC, Gelb AF, Mahler DA, Webb KA: Pathophysiology of dyspnoea in COPD. Proc Am Thorac Soc. 2007, 4: 145-168.CrossRefPubMed
4.
go back to reference Hammond E: Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. Am J Pub Health. 1964, 54: 11-23. 10.2105/AJPH.54.1.11.CrossRefPubMedPubMedCentral Hammond E: Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. Am J Pub Health. 1964, 54: 11-23. 10.2105/AJPH.54.1.11.CrossRefPubMedPubMedCentral
5.
go back to reference Currow DC, Plummer J, Crockett A, Abernethy AP: A community population survey of prevalence and severity of dyspnoea in adults. J Pain Symptom Manage. 2009, 38 (4): 533-545. 10.1016/j.jpainsymman.2009.01.006.CrossRefPubMed Currow DC, Plummer J, Crockett A, Abernethy AP: A community population survey of prevalence and severity of dyspnoea in adults. J Pain Symptom Manage. 2009, 38 (4): 533-545. 10.1016/j.jpainsymman.2009.01.006.CrossRefPubMed
6.
go back to reference Bestall JC, Paul EA, Goarrod R, Garnham R, Jones PW, Wedzicha JA: Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999, 54: 581-586. 10.1136/thx.54.7.581.CrossRefPubMedPubMedCentral Bestall JC, Paul EA, Goarrod R, Garnham R, Jones PW, Wedzicha JA: Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999, 54: 581-586. 10.1136/thx.54.7.581.CrossRefPubMedPubMedCentral
7.
go back to reference Fletcher CM, Elmes PC, Fairbairn SA, Wood CH: The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J. 1959, 2: 257-66. 10.1136/bmj.2.5147.257.CrossRefPubMedPubMedCentral Fletcher CM, Elmes PC, Fairbairn SA, Wood CH: The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J. 1959, 2: 257-66. 10.1136/bmj.2.5147.257.CrossRefPubMedPubMedCentral
8.
go back to reference Anon : Australian Bureau of Statistics, 2001, Socio-Economic Indexes for Areas, Cat no.2039.0. Canberra, Australia Anon : Australian Bureau of Statistics, 2001, Socio-Economic Indexes for Areas, Cat no.2039.0. Canberra, Australia
11.
go back to reference Hosmer D, Lemeshow S: Applied Logistic Regression. 2000, United States of America: John Wiley and Sons, Inc, SecondCrossRef Hosmer D, Lemeshow S: Applied Logistic Regression. 2000, United States of America: John Wiley and Sons, Inc, SecondCrossRef
12.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP: STROBE Initiative. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007, 335: 806-808. 10.1136/bmj.39335.541782.AD.CrossRefPubMedPubMedCentral von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP: STROBE Initiative. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007, 335: 806-808. 10.1136/bmj.39335.541782.AD.CrossRefPubMedPubMedCentral
13.
go back to reference Berner YN: The contribution of obesity to dyspnoea in elderly people. Age Ageing. 2001, 30 (6): 530-10.1093/ageing/30.6.530.CrossRefPubMed Berner YN: The contribution of obesity to dyspnoea in elderly people. Age Ageing. 2001, 30 (6): 530-10.1093/ageing/30.6.530.CrossRefPubMed
14.
go back to reference Main ML, Rao SC, O'Keefe JH: Trends in obesity and extreme obesity among US adults. JAMA. 2010, 303 (17): 1695-10.1001/jama.2010.517.CrossRefPubMed Main ML, Rao SC, O'Keefe JH: Trends in obesity and extreme obesity among US adults. JAMA. 2010, 303 (17): 1695-10.1001/jama.2010.517.CrossRefPubMed
15.
go back to reference Peto R, Whitlock , Jha B: Effects of obesity and smoking on U.S. life expectancy. N Engl J Med. 2010, 362 (9): 855-857. 10.1056/NEJMc1000079.CrossRefPubMed Peto R, Whitlock , Jha B: Effects of obesity and smoking on U.S. life expectancy. N Engl J Med. 2010, 362 (9): 855-857. 10.1056/NEJMc1000079.CrossRefPubMed
16.
go back to reference Ora J, Laveneziana P, Ofir D, Deesomchok A, Webb KA, O'Donnell DE: Combined effects of obesity and chronic obstructive pulmonary disease on dyspnoea and exercise tolerance. Am J Respir Crit Care Med. 2009, 180 (10): 964-71.CrossRefPubMed Ora J, Laveneziana P, Ofir D, Deesomchok A, Webb KA, O'Donnell DE: Combined effects of obesity and chronic obstructive pulmonary disease on dyspnoea and exercise tolerance. Am J Respir Crit Care Med. 2009, 180 (10): 964-71.CrossRefPubMed
17.
go back to reference Laviolette L, Sava F, O'Donnell DE, Webb KA, Hamilton AL, Kesten S, Maltais F: Effect of obesity on constant workrate exercise in hyperinflated men with COPD. BMC Pulm Med. 2010, 10 (1): 33-10.1186/1471-2466-10-33.CrossRefPubMedPubMedCentral Laviolette L, Sava F, O'Donnell DE, Webb KA, Hamilton AL, Kesten S, Maltais F: Effect of obesity on constant workrate exercise in hyperinflated men with COPD. BMC Pulm Med. 2010, 10 (1): 33-10.1186/1471-2466-10-33.CrossRefPubMedPubMedCentral
18.
go back to reference Goyal D, Logie IM, Nadar SK, Lip GY, Macfadyen RJ: Generalized obesity but not that characterized by raised waist-hip ratio is associated with increased perceived breathlessness during treadmill exercise testing. Cardiovasc Ther. 2009, Spring, 27 (1): 10-6. 10.1111/j.1755-5922.2008.00067.x. Goyal D, Logie IM, Nadar SK, Lip GY, Macfadyen RJ: Generalized obesity but not that characterized by raised waist-hip ratio is associated with increased perceived breathlessness during treadmill exercise testing. Cardiovasc Ther. 2009, Spring, 27 (1): 10-6. 10.1111/j.1755-5922.2008.00067.x.
19.
go back to reference Babb TG, Wyrick BL, DeLorey DS, Chase PJ, Feng MY: Fat distribution and end-expiratory lung volume in lean and obese men and women. Chest. 2008, 134: 704-711. 10.1378/chest.07-1728.CrossRefPubMed Babb TG, Wyrick BL, DeLorey DS, Chase PJ, Feng MY: Fat distribution and end-expiratory lung volume in lean and obese men and women. Chest. 2008, 134: 704-711. 10.1378/chest.07-1728.CrossRefPubMed
20.
go back to reference Kress JP, Pohlman AS, Alverdy J, Hall JB: The impact of obesity on oxygen cost of breathing (VO2Resp) at rest. Am J Respir Crit Care Med. 1999, 160: 883-886.CrossRefPubMed Kress JP, Pohlman AS, Alverdy J, Hall JB: The impact of obesity on oxygen cost of breathing (VO2Resp) at rest. Am J Respir Crit Care Med. 1999, 160: 883-886.CrossRefPubMed
21.
go back to reference Franssen FME, O'Donnell DE, Goossens GH, Blaak EE, Schols AMWJ: Obesity and the lung: 5 • Obesity and COPD. Thorax. 2008, 63: 1110-1117. 10.1136/thx.2007.086827.CrossRefPubMed Franssen FME, O'Donnell DE, Goossens GH, Blaak EE, Schols AMWJ: Obesity and the lung: 5 • Obesity and COPD. Thorax. 2008, 63: 1110-1117. 10.1136/thx.2007.086827.CrossRefPubMed
23.
go back to reference U.S. Department of Health and Human Services: The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General--Executive Summary. 2006, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health U.S. Department of Health and Human Services: The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General--Executive Summary. 2006, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health
25.
go back to reference El-Gamal H, Khayat A, Shikora S, Unterborn JN: Relationship of dyspnoea to respiratory drive and pulmonary function tests in obese patients before and after weight loss. Chest. 2005, 128: 3870-4. 10.1378/chest.128.6.3870.CrossRefPubMed El-Gamal H, Khayat A, Shikora S, Unterborn JN: Relationship of dyspnoea to respiratory drive and pulmonary function tests in obese patients before and after weight loss. Chest. 2005, 128: 3870-4. 10.1378/chest.128.6.3870.CrossRefPubMed
26.
go back to reference Bausewein C, Booth S, Gysels M, Higginson I: Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev. 2008, 2: CD005623-PubMed Bausewein C, Booth S, Gysels M, Higginson I: Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev. 2008, 2: CD005623-PubMed
27.
go back to reference Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C: Randomised double-blind placebo-controlled crossover trial of sustained-release morphine for the management of refractory dyspnoea. Br Med J. 2003, 327 (7414): 523-25. 10.1136/bmj.327.7414.523.CrossRef Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C: Randomised double-blind placebo-controlled crossover trial of sustained-release morphine for the management of refractory dyspnoea. Br Med J. 2003, 327 (7414): 523-25. 10.1136/bmj.327.7414.523.CrossRef
28.
go back to reference Uronis HE, McCrory DC, Samsa GP, Currow DC, Abernethy AP: Palliative oxygen for non-hypoxaemic chronic obstructive pulmonary disease. 2008, [Protocol] Cochrane Airways Group. Cochrane Database of Systematic Reviews Uronis HE, McCrory DC, Samsa GP, Currow DC, Abernethy AP: Palliative oxygen for non-hypoxaemic chronic obstructive pulmonary disease. 2008, [Protocol] Cochrane Airways Group. Cochrane Database of Systematic Reviews
Metadata
Title
Predictors of chronic breathlessness: a large population study
Authors
Jacqueline A Bowden
Timothy HM To
Amy P Abernethy
David C Currow
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-33

Other articles of this Issue 1/2011

BMC Public Health 1/2011 Go to the issue