Prevalence and Burden of Breathlessness in Patients with Chronic Obstructive Pulmonary Disease Managed in Primary Care
Open accessAbstract
BACKGROUND & AIMS: Breathlessness is a primary clinical feature of chronic obstructive pulmonary disease (COPD). We aimed to describe the frequency of and factors associated with breathlessness in a cohort of COPD patients identified from the Clinical Practice Research Datalink (CPRD), a general practice electronic medical records database. METHODS: Patients with a record of COPD diagnosis after January 1 2008 were identified in the CPRD. Breathlessness was assessed using the Medical Research Council (MRC) dyspnoea scale, with scoring ranging from 1-5, which has been routinely administered as a part of the regular assessment of patients with COPD in the general practice since April 2009. Stepwise multivariate logistic regression estimated independent associations with dyspnoea. Negative binomial regression evaluated a relationship between breathlessness and exacerbation rate during follow-up. RESULTS: The total cohort comprised 49,438 patients diagnosed with COPD; 40,425 (82%) had any MRC dyspnoea grade recorded. Of those, 22,770 (46%) had moderate-to-severe dyspnoea (MRC ≥ 3). Breathlessness increased with increasing airflow limitation; however, moderate-to-severe dyspnoea was also observed in 32% of patients with mild airflow obstruction. Other factors associated with increased dyspnoea grade included female gender, older age (≥ 70 years), obesity (BMI ≥ 30), history of moderate-to-severe COPD exacerbations, and frequent visits to the general practitioner. Patients with worse breathlessness were at higher risk of COPD exacerbations during follow-up. CONCLUSIONS: Moderate-to-severe dyspnoea was reported by >40% of patients diagnosed with COPD in primary care. Presence of dyspnoea, including even a perception of mild dyspnoea (MRC = 2), was associated with increased disease severity and a higher risk of COPD exacerbations during follow-up.
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Refractory breathlessness is highly prevalent and distressing in advanced chronic respiratory disease.
“Refractory breathlessness is a highly prevalent and distressing symptom in advanced chronic respiratory disease.”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [2]
The Introduction describes dyspnoea as distressing and says that many patients with COPD continue to experience it despite available treatments. The Discussion reports that dyspnoea was highly prevalent across all stages of airflow limitation. The paper does not establish the prevalence of specifically refractory breathlessness in advanced chronic respiratory disease beyond COPD. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBreathlessness severity is not reliably predicted by the severity of airflow limitation/lung pathology in COPD.
“Its intensity is not reliably predicted by the severity of lung pathology”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [2]
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- Authors
- Müllerová, H., Lu, C., Li, H., & Tabberer, M.
- Affiliations
- GlaxoSmithKline (United Kingdom) (GB)
- GlaxoSmithKline (United States) (US)
- Corresponding author
- Müllerová, Hana
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-01-10
- Volume
- 9
- Issue
- 1
- Pages
- e85540
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3888425
- OpenAlex
- W2062066840
- Cited by
- 139
- References
- 43
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 15 · 2023: 6 · 2022: 17 · 2021: 15 · 2020: 11 · 2019: 9 · 2018: 17 · 2017: 10 · 2016: 9 · 2015: 4 · 2014: 2
- FWCI
- 6.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- GlaxoSmithKline
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Keywords
- chronic obstructive pulmonary disease, dyspnea, MRC dyspnoea scale, COPD exacerbations, airflow obstruction, disease severity, obesity, primary care
- MeSH terms
- Aged, Dyspnea, Female, Follow-Up Studies, Humans, Male, Middle Aged, Primary Health Care, Respiratory Function Tests, Risk Factors, Severity of Illness Index, Cohort Studies, Prevalence, Databases, Factual, Pulmonary Disease, Chronic Obstructive, Public Health Surveillance, Patient Outcome Assessment
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