Impact of Dyspnea on Adults With
Respiratory Symptoms Without a Deﬁned
Diagnosis
Jared Bierbrier, BSc; Emily Gerstein; George A. Whitmore, PhD; Katherine L. Vandemheen, MScN; Celine Bergeron, MD;
Louis-Philippe Boulet, MD; Andreanne Cote, MD; Stephen K. Field, MD; Erika Penz, MD; R. Andrew McIvor, MD;
Catherine Lemière, MD; Samir Gupta, MD; Paul Hernandez, MD; Irvin Mayers, MD; Mohit Bhutani, MD;
M. Diane Lougheed, MD; Christopher J. Licskai, MD; Tanweer Azher, MD; Nicole Ezer, MD; Martha Ainslie, MD;
Gonzalo G. Alvarez, MD; Sunita Mulpuru, MD; and Shawn D. Aaron, MD
BACKGROUND: We investigated dyspnea; its associated risk factors; and its impact on health
care utilization, quality of life, and work productivity in adults with undiagnosed respiratory
symptoms.
RESEARCH QUESTION:What is the impact of dyspnea in adults with undiagnosed respiratory
symptoms?
STUDY DESIGN AND METHODS:This population-based study included 2,857 adults who were
experiencing respiratory symptoms. These individuals had not been previously diagnosed
with any lung conditions and were recruited from 17 Canadian centers using random digit
dialing. Each participant underwent spirometry testing both before and after using a bron-
chodilator to determine if they met the diagnostic criteria for COPD, asthma, or preserved
ratio impaired spirometry (PRISm), or if their spirometry results were normal. An age-
matched control group (n ¼ 231) was similarly recruited using random digit dialing. A
dyspnea impact assessment score from 0 to 100 was produced using questions from the
COPD Assessment Test and St. George’s Respiratory questionnaire.
RESULTS: Individuals with PRISm (n¼ 172) reported more impactful dyspnea (mean score,
63.0; 95% CI, 59.5-66.4) than those with undiagnosed asthma (n¼ 265; mean score, 56.6;
95% CI, 53.9-59.3) or undiagnosed COPD (n¼ 330; mean score, 57.5; 95% CI, 55.1-59.9). All
groups reported signiﬁcantly more impactful dyspnea than the control group (mean score,
13.8; 95% CI, 11.8-15.7). Patient-speciﬁc risk factors including age, sex, BMI, smoking, and
comorbidities explained 20.6% of the variation in dyspnea. An additional 12.4% of the
variation was explained by disease classiﬁcation and another 1.7% by the severity of lung
function impairment assessed with spirometry. After adjusting for age, sex, and BMI, greater
dyspnea impact was associated with increased health care utilization, lower quality of life, and
reduced work productivity.
INTERPRETATION: Our ﬁndings showed that in community-based adults with undiagnosed
respiratory symptoms, those identiﬁed with PRISm experienced the greatest impact of dys-
pnea. Dyspnea imposes burdens on the health care system and is associated with impaired
quality of life and work productivity. CHEST 2024; 166(6):1296-1308
KEY WORDS:asthma; case ﬁnding; COPD; dyspnea
FOR EDITORIAL COMMENT, SEE PAGE 1259
[ Asthma Original Research ]
1296 Original Research [ 166#6 CHEST DECEMBER 2024 ]