Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study

A Müller; E F Wouters; P Koul; T Welte; I Harrabi; A Rashid; L C Loh; M Al Ghobain; A Elsony; R Ahmed; J Potts; K Mortimer; F Rodrigues; S N Paraguas; S Juvekar; D Agarwal; D Obaseki; T Gislason; T Seemungal; A A Nafees; C Jenkins; H B Dias; F M E Franssen; M Studnicka; C Janson; H H Cherkaski; M El Biaze; P A Mahesh; J Cardoso; P Burney; S Hartl; D J A Janssen; A F S Amaral

doi:10.1016/j.pulmoe.2024.03.005

Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Pulmonology. 2024 Apr 13:S2531-0437(24)00044-8. doi: 10.1016/j.pulmoe.2024.03.005. Online ahead of print.

Authors

A Müller¹, E F Wouters², P Koul³, T Welte⁴, I Harrabi⁵, A Rashid⁶, L C Loh⁷, M Al Ghobain⁸, A Elsony⁹, R Ahmed⁹, J Potts¹⁰, K Mortimer¹¹, F Rodrigues¹², S N Paraguas¹³, S Juvekar¹⁴, D Agarwal¹⁴, D Obaseki¹⁵, T Gislason¹⁶, T Seemungal¹⁷, A A Nafees¹⁸, C Jenkins¹⁹, H B Dias²⁰, F M E Franssen²¹, M Studnicka²², C Janson²³, H H Cherkaski²⁴, M El Biaze²⁵, P A Mahesh²⁶, J Cardoso²⁷, P Burney¹⁰, S Hartl²⁸, D J A Janssen²⁹, A F S Amaral³⁰

Affiliations

¹ Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Electronic address: alexander.mueller@leadstudy.at.
² Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
³ Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India.
⁴ Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany.
⁵ Faculté de Médecine, Sousse, Tunisia.
⁶ RCSI and UCD Malaysia Campus, Penang, Malaysia.
⁷ RUMC, Penang, Malaysia.
⁸ King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia.
⁹ The Epidemiological Laboratory, Khartoum, Sudan.
¹⁰ National Heart and Lung Institute, Imperial College London, London, UK.
¹¹ University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
¹² Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal.
¹³ Philippine College of Chest Physicians, Manila, Philippines.
¹⁴ KEM Hospital Research Centre, Pune, India.
¹⁵ Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada.
¹⁶ Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
¹⁷ Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago.
¹⁸ Aga Khan University, Karachi, Pakistan.
¹⁹ Woolcock Institute of Medical Research, Sydney, Australia.
²⁰ Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal.
²¹ Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands.
²² Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
²³ Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
²⁴ Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria.
²⁵ Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco.
²⁶ Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India.
²⁷ Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal.
²⁸ Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria.
²⁹ Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands.
³⁰ National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK.

PMID: 38614859
DOI: 10.1016/j.pulmoe.2024.03.005

Abstract

Background: Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function.

Methods: Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis.

Results: The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC<LLN: OR 2.07, 95 %CI 1.75-2.45) and spirometry airflow obstruction (FEV₁/FVC<LLN: OR 3.76, 95 %CI 1.04-4.65). These associations did not significantly differ between sexes, age groups or smoking history. The association of dyspnoea with airflow obstruction was weaker among obese participants (OR 2.20, 95 %CI 1.61-3.01).

Conclusion: The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.

Keywords: Breathlessness; Dyspnoea; Lung function; Spirometry.