Don’t treat shortness of breath as trivial, GPs urged
Author: Caroline White
While a common symptom, shortness of breath shouldn’t be dismissed as trivial and not investigated further, GPs have been warned.
It’s a strong indicator of future serious respiratory and heart problems and early death, say researchers at the Universities of Keele and Nottingham, working with the British Lung Foundation, in what is thought to be the first study* of its kind, published in The British Journal of General Practice.
They drew on entries to the Clinical Practice Research Datalink, to study over 75,000 adults from 360 GP surgeries whose health was tracked for more than six years after their first recorded consultation in general practice for breathlessness between 1997 and 2010.
Over a third of them were subsequently diagnosed with asthma, chronic obstructive pulmonary disease (COPD), or ischaemic heart disease during the monitoring period.
After taking account of potentially influential factors, such as underlying conditions, the risk of a COPD diagnosis was nearly nine times that of matched patients without breathlessness, while the risk of asthma was 12 times higher, and heart disease three times higher in the six to 12 months after the first consultation for breathlessness.
It also took longer to diagnose patients with breathlessness who had no relevant prescription in the six months following their first consultation for the symptom, representing a “missed opportunity,” suggest the researchers.
And compared with the matched patients, those who experienced breathlessness were also more likely to die of any cause.
“All-cause mortality in the first six months after initial breathlessness symptom was particularly high and it is possible the symptom may have been related to an underlying terminal disease. However, there were also increased long-term risks (>6 months) for disease-specific mortality, which remained after adjustment for later diagnosis,” write the researchers.
“This indicates that, in addition to being a marker of underlying diseases such as COPD, asthma, and IHD, breathlessness remains an independent marker of long-term mortality risk.”
Primary care clinicians, including out-of-hours providers, who see patients with breathlessness should be aware that although the symptoms may represent self-limiting disorders, they are also associated with a heightened risk of more serious problems in the future, including premature death, say the researchers.
COPD, asthma and ischaemic heart disease need to be investigated earlier to confirm or rule out disease, although further research is needed to establish which patients would benefit from early interventions, they add.
“These findings suggest a potential for more detailed investigation, monitoring, and early intervention among patients presenting with breathlessness; future studies need to establish whether this is feasible and cost-effective, and how to identify which patients would benefit,” they conclude.
*Ying C, Hayward R, Chew-Graham CA, et al. Prognostic value of first-recorded breathlessness for future chronic respiratory and heart disease a cohort study using a UK national primary care database. British Journal of General Practice 2020. DOI:10.3399/bjgp20X708221