Underpresentation of shortness of breath in the general population: Results of the DIMCA programme

Objectives: To investigate the extent of underpresen-tation of shortness of breath to general practitioners (GPs) in a random sample of the general population without a confirmed diagnosis of obstructive airways disease (OAD). A second objective was to assess the influence of a person's perception of symptoms and psychological factors as possible causes for under-presentation. Design: A random sample of the general population ( n = 1155) was screened for respiratory symptoms. Of those who experienced shortness of breath at some stage during the preceding year, the ability to perceive dyspnoea was assessed in 134 patients, by means of a Borg score and a visual analogue scale (VAS) during each step of a histamine provocation test. A psychological profile was assessed in 130 subjects using five validated questionnaires. Patients: Two random sample groups ( n = 134 and n = 130) of adults reporting dyspnoea without a diagnosis of OAD. Results: Of the initial sample, 285 (25%) had experienced shortness of breath in the year preceding the screening: only 93/285 (33%) had ever consulted their GP for this. Multivariate analysis showed that neither a person's perception of dyspnoea nor psychological factors could explain underpresentation. Conclusions: Underpresentation of symptoms is a major factor contributing to underdiagnosis of OAD, but this is not related to the patient’s perception of symptoms nor to their psychological profile.