INTRODUCTION: Sexual life is important for many people and may be limited by breathlessness. We evaluated associations between breathlessness and individuals' perceived satisfaction with sexual lives and explored mediating factors in this relationship.

METHODS: A cross-sectional, online, population-based survey of Australian adults with key demographics (age, sex, rurality, state/territory) reflected the 2016 national census. Assessments included: demographics, breathlessness (modified Medical Research Council (mMRC) scale); satisfaction with overall sexual life; whether breathlessness had affected overall sexual life and physical, social and emotional functioning. Binomial and ordinal logistic regression evaluated associations; a structural equation model evaluated direct, indirect and total associations.

RESULTS: Of 10 033 respondents (52% women; mean age 45.4 (SD 18.6)), 4245/10 033 (42%) reported mMRC ≥1, 1214/10 033 (12%) reported being very dissatisfied with their overall sexual life and 943/10 033 (9%) reported that breathlessness had impacted their overall sexual life. Compared with mMRC 0, there was an unadjusted association between mMRC 1 and satisfaction with overall sexual life which remained after adjusting for age, sex and body mass index (adjusted OR (aOR): 1.50; 95% CI 1.29 to 1.74).Breathlessness severity was associated with worse unadjusted and adjusted impact on overall sexual life: mMRC 0 versus mMRC 1 (aOR: 1.84; 95% CI 1.36 to 2.47). The associations increased stepwise for each higher mMRC level. There may be moderation of the effect of breathlessness on satisfaction with sexual life through emotional functioning.

CONCLUSIONS: Increasing breathlessness severity increases the likelihood of a person's overall sexual life being impacted negatively, potentially mediated partly through emotional functioning. 

Background: Breathlessness is common, anxiety-provoking, and challenging to clarify in primary care. When it persists beyond four weeks, it markedly impairs quality of life, functional capacity, and prognosis, and can trigger urgent consultations if underlying causes are not recognized and managed. Chronic breathlessness is frequently multifactorial, combining cardiopulmonary disease with obesity, deconditioning, breathing pattern disorders, anxiety, anemia, and post-coronavirus disease 2019 conditions.

Objective: This technical sheet aimed to provide primary care physicians with a structured, pragmatic, person-centered approach to the assessment and management of chronic breathlessness.

Content: This technical sheet emphasized early identification of acute/urgent presentations of breathlessness in adults (including pulse oximetry when available), systematic evaluation (history, examination, accessible investigations such as spirometry, chest radiography, electrocardiogram, complete blood count, N-terminal pro–B-type natriuretic peptide, and screening for anxiety/depression and physical activity level), and staged diagnostic reasoning that may require several visits while safely managing uncertainty. Management includes optimizing treatment of underlying conditions according to national guidance and early introduction of evidence-based non-pharmacological strategies. The breathing–thinking–functioning model is proposed to structure symptom control: correcting maladaptive breathing patterns, addressing fear and distress, and tackling deconditioning through appropriate rehabilitation and activity support.

Conclusion: A structured primary-care pathway combined with early non-pharmacological interventions can improve consultations, support self-management, and enhance outcomes in adults with chronic breathlessness. 

Background: Loss of, or unwanted changes in employment reduces economic wellbeing and is associated with lower quality of life. People living with chronic breathlessness are less likely to participate in the workforce. The influence of breathlessness on change in employment status is unknown. This study investigates associations between self-reported breathlessness limiting exertion (hereafter breathlessness) and changes in employment status.

Methods: Cross-sectional, online population survey of individuals aged 18–65 years old from Australia. Current and change of employment status, and breathlessness (assessed using modified Medical Research Council [mMRC] ≥ 1) were analysed using multivariate logistic regression to establish odds ratio (OR) and 95% confidence intervals (95%CI), adjusted for possible confounding effects.

Results: Eight thousand people were included; 5,730 (72%) were employed and 43% reported breathlessness. Breathlessness was associated with a change from full-time employment to another employment status: mMRC1 OR: mMRC1 OR: 6.60 (3.4–13.7); mMRC2 OR: 15.7 (7.7–34.2); and mMRC3-4 OR: 31.9 (13.8–75.4); and with being unemployed: mMRC1 OR: 1.20 (1.05–1.4); mMRC2 OR: 1.57 (1.3–1.9); and mMRC3-4 OR: 1.59 (1.1–2.3).

Conclusion: Breathlessness is associated with lower rates of employment and a higher probability of reducing work hours or becoming unemployed. The presence of chronic breathlessness should lead health professionals to explore the employment (and financial) consequences for the person. 

Background and objective Chronic breathlessness is common and often leads to avoidance of symptomprovoking activities. Expectations of breathlessness influence behaviour and symptom perception, but the accuracy of these expectations remains unclear. The aim of this study was to examine the relationship between expected and experienced breathlessness, the moderating role of mental states, determinants of expectation accuracy and the influence of recent symptoms on future expectations.

Methods In this longitudinal study, 83 participants with chronic breathlessness rated expected and experienced breathlessness (on 0-10 numerical rating scales (NRS)) using a mobile ecological momentary assessment app over 7 days. Associations were analysed using linear and mixed regression models.

Results Expected breathlessness was significantly associated with subsequently experienced breathlessness ([3=0.51, 95% CI 0.35-0.68) but was systematically overestimated (mean +/- SD expected 4.7 +/- 1.9 versus experienced 2.9 +/- 1.7; mean absolute difference 2.0 +/- 1.5). Depressive symptoms attenuated the association ([3=0.40, 95% CI 0.23-0.58), whereas anxiety, wellbeing and self-efficacy were not associated with either the strength or the accuracy of expectations. Expected breathlessness for the upcoming week was strongly related to the experience during the study week ([3=0.85, 95% CI 0.61-1.08, R2=0.48), suggesting recent experience shapes expectations more than expectations predict future breathlessness.

Conclusion Individuals with chronic breathlessness overestimated future breathlessness by a mean of 2 NRS points. Indication of depressive symptoms influenced the strength of the association, but accuracy appears unaffected by mental state indicators. These findings highlight the need to address and recalibrate symptom expectations in clinical care.

Purpose of review – To summarize and critically interpret new evidence (from the last 12–18 months) on the associations between obesity and breathlessness, including epidemiology, physiological mechanisms, diagnostic challenges, and treatment approaches. Recent findings – Multiple large cohorts confirm that obesity is one of the strongest independent predictors of exertional breathlessness. Recent work has expanded the understanding of mechanical, metabolic, and ventilatory contributors to breathlessness in obesity. Novel spirometric and oscillometric data clarify small airway dysfunction and decreased lung compliance. Obesity-related cardiac loading could be an important and potentially treatable contributor to breathlessness. Interventional studies show improvements in breathlessness following weight loss, particularly after bariatric procedures, though data on pharmacologic weight-loss therapies remain limited. Summary – Obesity is strongly associated with breathlessness and likely contributes through combined mechanical, metabolic, and ventilatory factors. Treatment remains centred on weight loss, but the evidence is scarce. Future work should prioritize breathlessness-specific outcomes in obesity interventions. 

Breathlessness is a common symptom in clinical practice, yet evidence for cost-effective strategies to diagnose the underlying health conditions causing breathlessness remains limited. Using Swedish population data with individuals with moderate to severe breathlessness, we developed an artificial intelligence (AI) reinforcement learning model to identify optimal, low-cost diagnostic pathways for breathlessness tailored to subgroups based on sex and smoking exposure. Sixteen clinically relevant conditions were defined, along with their diagnostic tests and standard healthcare costs. The AI-based approach successfully produced efficient and low-cost diagnostic pathways for breathlessness with high diagnostic yield. The optimal sequences were overall similar between the subgroups. For all participant subgroups, the AI-derived pathways initially identified (or order of effectiveness in relation to costs) clinical evaluations of body mass index, anxiety and depression, physical activity levels, and spirometry. Subsequent steps included diffusing capacity measurements, chest computer tomography, and hemoglobin assessment. Overall, investigations of the lungs were prioritized ahead of investigations of the heart. This strategy has the potential to streamline the evaluation of breathlessness, reduce unnecessary testing, lead to an earlier diagnosis at lower cost, and support more targeted clinical management.

Background Long-term pathological breathlessness is a life-limiting symptom that risks taking control of the individual’s life. We aimed to evaluate how locus of control (LOC), an individual’s perceived control of present and past life events, relates to breathlessness in a middle-aged general population.

Methods A population-based, cross-sectional analysis of people aged 50–64 years was conducted in the Swedish CArdioPulmonary bioImage Study (SCAPIS). Breathlessness was measured using the modified Medical Research Council (mMRC) breathlessness scale. LOC was assessed using five-point scales related to work, life events, perceived future, treated by other people, past changes and life improvements. The LOC factors were dichotomised as having an external or internal LOC. Logistic regression was used to examine the association between external LOC and presence of moderate/severe breathlessness (mMRC ⩾2). Associations between external LOC and higher breathlessness severity score (mMRC 0–4) were analysed using ordinal regression. The models were adjusted for age, sex, education level, pack-years of smoking, body mass index, lung function, depression and cardiorespiratory diseases.

Results Of 28 730 participants (52% women), 4% experienced breathlessness. Breathlessness was related to external LOC in relation to life events (odds ratio (OR) 1.47, 95% confidence interval (CI) 1.26–1.71), future (OR 1.89, 95% CI 1.53–2.34), treated unfairly (OR 1.73, 95% CI 1.42–2.09), past changes (OR 1.50, 95% CI 1.30–1.74) and life improvements (OR 2.91, 95% CI 2.35–3.59). External LOC was associated with increased breathlessness severity.

Conclusion External LOC is associated with experiencing worse breathlessness, and the identified LOC factors can be considered in future intervention studies aiming to reduce the suffering from breathlessness. 

Background: Breathlessness is a common and distressing symptom across a wide range of medical conditions. Different aspects (dimensions) of breathlessness can be assessed using the Multidimensional Dyspnoea Profile (MDP) and Dyspnoea-12 (D12) questionnaires. We aimed to examine whether the order of completing MDP and D12 affects the breathlessness responses in people with cardiorespiratory disease.

Methods: This was a randomised controlled trial embedded within a longitudinal clinical study. Outpatients with cardiorespiratory disease were randomly assigned to either first complete the MDP or the D12. Primary outcome was mean difference in D12 total score between groups, secondary outcome was mean difference in D12 and MDP subdomain scores. Both outcomes were compared to the minimal clinically important difference (MCID) for each scale.

Results: All 182 participants from the longitudinal study were included. 93 were randomized to complete MDP first and 89 to D12 first. Characteristics such as age, sex, main cause of breathlessness and smoking status were similar between groups. The mean difference for D12 total score (MCID = 2.8) was −1.5 (−4.2 to 1.3, p = 0.26) between groups. Mean differences between groups in subdomain scores were also below the corresponding MCID.

Conclusion: The order of completion of MDP and D12 did not impact the scores significantly, but the study lacked power to find smaller yet clinically significant differences. The study supports that the most practical order of completing the instruments can be used in future research and in clinical settings.