Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults

Abstract

Background and Objective Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults. Methods A cross‐sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self‐reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant‐reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. Results Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co‐morbid conditions, the aRR was slightly attenuated to around 1.85–1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1–29.1) and after further adjustment for co‐morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. Conclusion Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity.

Obesity is a major contributing cause of breathlessness in the population

“…In a representative sample of 9769 adults (51% women) in Australia, breathlessness was defined as a self‐reported modified Medical Research Council (mMRC) score ≥2, corresponding to ‘I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level’, or worse. Extending a previous report using the same database of the prevalence of obesity (28%) and breathlessness (10%), 2 they now estimated an obesity population attributable fraction (PAF) for breathlessness of about 22% (95% confidence intervals, 17%–27%) 8 . This finding means that obesity contributed to an estimated 22% of cases of breathlessness in the study population, when accounting for different sets of potential confounders.…”

“…4,5 Compared with people with normal BMI, breathlessness is more common in people with underweight (BMI <18.5), overweight (BMI 25-30) and especially with obesity (BMI >30)-also after controlling for known confounders such as the presence of other medical conditions. 3,4,6,7 In a recent publication in Respirology, Guo et al 8 take a further step to evaluate the contribution of obesity to breathlessness in the population. In a representative sample of 9769 adults (51% women) in Australia, breathlessness was defined as a self-reported modified Medical Research Council (mMRC) score ≥2, corresponding to 'I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level', or worse.…”

“…In a recent publication in Respirology , Guo et al 8 take a further step to evaluate the contribution of obesity to breathlessness in the population. In a representative sample of 9769 adults (51% women) in Australia, breathlessness was defined as a self‐reported modified Medical Research Council (mMRC) score ≥2, corresponding to ‘I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level’, or worse.…”

Diagnostic delays for breathlessness in primary care: a qualitative study to investigate current care and inform future pathways

“…(10) The Australian national breathlessness survey found that obesity accounted for a quarter of breathlessness symptoms in adults. (12) Deconditioning is a likely important contributing factor that is currently less well quantified. (13) Despite the impact breathlessness has on quality of life (14), sufferers may delay seeking help, normalising their symptoms, (15,16) and frequently experience significant delays in diagnosis and treatment after seeking help.…”

“… 10 The Australian National Breathlessness Survey found that obesity accounted for a quarter of breathlessness symptoms in adults. 12 Deconditioning is a likely important contributing factor that is currently less well quantified. 13 …”