Prevalence of Chronic Breathlessness Syndrome
The prevalence of chronic breathlessness syndrome ranges from 9-13% among community-residing adults, increasing to 15-18% in adults over 40 years, and 25-37% in adults aged 70 years and older. 1
Definition and Characteristics
Chronic breathlessness syndrome is defined as breathlessness that:
- Persists despite optimal treatment of the underlying pathophysiology
- Results in disability
- Requires symptomatic management
This syndrome can manifest as:
- Chronic breathlessness (constantly present with usual fluctuations)
- Episodic breathlessness (severe worsening beyond usual fluctuations)
- Acute breathlessness
Prevalence by Population
General Population
- 9-13% for mild to moderate dyspnea among community-residing adults 1
- 15-18% among adults aged 40 years or older 1
- 25-37% among adults aged 70 years and older 1
Disease-Specific Populations
- Nearly 90% of people with advanced heart failure report breathlessness 1
- 53% of COPD patients in tertiary care settings have severe breathlessness (mMRC scale ≥3) despite optimal inhaled medications 2
Impact on Daily Life
Chronic breathlessness syndrome significantly impacts quality of life:
- Substantially limits daily activities such as bathing or dressing in advanced heart failure patients 1
- Causes progressive reduction in activities as breathlessness severity increases 3
- For people with mMRC 1 breathlessness, 35% had not given up any activity
- For people with mMRC 2, only 9% maintained all activities
- For people with mMRC 3-4, only 3% maintained all activities 3
The most commonly forgone activities include:
- Intense sports (jogging, bike riding): 42% (mMRC 1), 32% (mMRC 2), 36% (mMRC 3-4)
- Sexual activities: 14% (mMRC 3-4)
- Lower intensity sports: 11% (mMRC 3-4) 3
Associated Conditions
Chronic breathlessness is associated with multiple underlying conditions:
- Respiratory diseases (40-57% of cases) - most common underlying condition 4
- Asthma (approximately 25% of cases)
- COPD (particularly strongly associated with breathlessness)
- Heart diseases
- Anxiety and depression
- Obesity 4
In COPD patients, severe breathlessness is associated with:
- Increased symptoms of anxiety and depression
- Higher prevalence of osteoporosis 2
Clinical Significance
Chronic breathlessness has significant prognostic implications:
- Predicts hospitalization and mortality in patients with chronic lung disease 1
- More closely correlated with 5-year survival than FEV1 in some cases 1
- More closely associated with cardiac mortality than angina 1
Management Gaps
Despite the high prevalence and impact of chronic breathlessness syndrome:
- Treatment approaches to breathlessness and associated psychological distress are insufficient 2
- Underutilization of pulmonary rehabilitation and symptomatic treatments is common 2
- Among patients with chronic breathlessness and anxiety/depression, only 25% receive appropriate psychiatric treatment 2
Pitfalls in Recognition and Management
- Chronic breathlessness is often "invisible" because:
- People may not engage with the healthcare system
- Both clinicians and patients are reluctant to discuss breathlessness in consultations 5
- Breathlessness itself is often not seen as a target for therapeutic interventions 6
- Breathlessness which persists despite optimum treatment is frequently self-managed by patients without medical help 6
Improving recognition and assessment of chronic breathlessness syndrome is essential to ensure appropriate management and improve quality of life for affected individuals.