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Cited by 140Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesSmoking Behavior and Cessation

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Prevalence and Burden of Breathlessness in Patients with Chronic Obstructive Pulmonary Disease Managed in Primary Care

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Müllerová, Hana, Lu, Chao, Li, Hao, Tabberer, Maggie·2014·PLoS ONE
DOI 10.1371/journal.pone.0085540PMC PMC3888425
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Abstract

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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Crossref · 10.1371/journal.pone.0085540

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Figure 1 Cohort selection: flow diagram. Abbreviations: COPD, chronic obstructive pulmonary disease; FEV1/FVC, forced expiratory volume in 1 second/forced vital capacity; GPRD, General Practice Research Database; MRC, Medical Research Council.
Figure 1 Cohort selection: flow diagram. Abbreviations: COPD, chronic obstructive pulmonary disease; FEV1/FVC, forced expiratory volume in 1 second/forced vital capacity; GPRD, General Practice Research Database; MRC, Medical Research Council.CC BY · PubMed Central
Figure 2 Distribution of MRC dyspnoea grade in the COPD cohort (first MRC grade from the study start). Abbreviations: COPD, chronic obstructive pulmonary disease; MRC, Medical Research Council. MRC scoring 1–5 equals to mMRC grades 0–4 with MRC 1 equals to mMRC 0.
Figure 2 Distribution of MRC dyspnoea grade in the COPD cohort (first MRC grade from the study start). Abbreviations: COPD, chronic obstructive pulmonary disease; MRC, Medical Research Council. MRC scoring 1–5 equals to mMRC grades 0–4 with MRC 1 equals to mMRC 0.CC BY · PubMed Central
Figure 3 MRC dyspnoea grade distribution by stage of airflow limitation (first MRC grade from study start). Abbreviations: COPD, chronic obstructive pulmonary disease; MRC, Medical Research Council. MRC scoring 1–5 equals to mMRC grades 0–4 with MRC 1 equals to mMRC 0.
Figure 3 MRC dyspnoea grade distribution by stage of airflow limitation (first MRC grade from study start). Abbreviations: COPD, chronic obstructive pulmonary disease; MRC, Medical Research Council. MRC scoring 1–5 equals to mMRC grades 0–4 with MRC 1 equals to mMRC 0.CC BY · PubMed Central
Figure 4 Bivariate relationship between FEV1% predicted and MRC grade: scatter plot. Abbreviations: FEV1%predicted, forced expiratory volume in one second; Stage I: FEV1≥80% predicted; Stage II: ≥50% to <80% FEV1 predicted; Stage III: ≥30% to <50% FEV1 predicted; Stage IV: >30% FEV1 predicted; MRC, Medical Research Council. MRC scoring 1–5 equals to mMRC grades 0–4 with MRC 1 being equal to mMRC 0.
Figure 4 Bivariate relationship between FEV1% predicted and MRC grade: scatter plot. Abbreviations: FEV1%predicted, forced expiratory volume in one second; Stage I: FEV1≥80% predicted; Stage II: ≥50% to <80% FEV1 predicted; Stage III: ≥30% to <50% FEV1 predicted; Stage IV: >30% FEV1 predicted; MRC, Medical Research Council. MRC scoring 1–5 equals to mMRC grades 0–4 with MRC 1 being equal to mMRC 0.CC BY · PubMed Central
Figure 5 Line plot of mean BMI and MRC grade. Abbreviations: BMI, body mass index; MRC, Medical Research Council. MRC scoring 1–5 equals to mMRC grades 0–4 with MRC 1 equals to mMRC 0.
Figure 5 Line plot of mean BMI and MRC grade. Abbreviations: BMI, body mass index; MRC, Medical Research Council. MRC scoring 1–5 equals to mMRC grades 0–4 with MRC 1 equals to mMRC 0.CC BY · PubMed Central

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Metadata

Authors
Müllerová, H., Lu, C., Li, H., & Tabberer, M.
Affiliations
  • GlaxoSmithKline (United Kingdom) (GB)
  • GlaxoSmithKline (United States) (US)
Corresponding author
Müllerová, Hana
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2014-01-10
Volume
9
Issue
1
Pages
e85540
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0085540
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
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 › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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