Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan 10;9(1):e85540.
doi: 10.1371/journal.pone.0085540. eCollection 2014.

Prevalence and burden of breathlessness in patients with chronic obstructive pulmonary disease managed in primary care

Hana Müllerová  1 , Chao Lu  2 , Hao Li  2 , Maggie Tabberer  3
Affiliations

Prevalence and burden of breathlessness in patients with chronic obstructive pulmonary disease managed in primary care

Hana Müllerová et al. PLoS One. .

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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: This study was funded by GlaxoSmithKline Research and Development (R&D) (Protocol WEUSKOP5224). All authors are employees of GlaxoSmithKline R&D and own stocks and shares of GlaxoSmithKline Plc. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1
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 2
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 3
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 4
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 5
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.
See this image and copyright information in PMC

References

    1. Gold Initiative for Chronic Obstructive Lung Disease. (2011) Global strategy for diagnosis, management, and prevention of COPD. Available: http://www goldcopd org/guidelines-global-strategy-for-diagnosis-management html. Accessed 3rd December 2012.
    1. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, et al. (1999) Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 54(7): 581–586. - PMC - PubMed
    1. Sarkar S, Amelung PJ (2006) Evaluation of the dyspneic patient in the office. Prim Care 33(3): 643–657. - PubMed
    1. Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, et al. (2012) An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 185(4): 435–452. - PMC - PubMed
    1. Jolley CJ, Moxham J (2009) A physiological model of patient-reported breathlessness during daily activities in COPD. Eur Respir Rev 18(112): 66–79. - PubMed

Publication types

MeSH terms