Respiratory Symptoms among US Adults: a Cross-Sectional Health Survey Study

Roy A Pleasants; Khosrow Heidari; Jill Ohar; James F Donohue; Njira L Lugogo; Sarojini M Kanotra; Monica Kraft; David M Mannino; Charlie B Strange

doi:10.1007/s41030-022-00194-9

Respiratory Symptoms among US Adults: a Cross-Sectional Health Survey Study

Pulm Ther. 2022 Sep;8(3):255-268. doi: 10.1007/s41030-022-00194-9. Epub 2022 Jul 6.

Authors

Roy A Pleasants¹, Khosrow Heidari², Jill Ohar³, James F Donohue⁴, Njira L Lugogo⁵, Sarojini M Kanotra⁶, Monica Kraft⁷, David M Mannino⁸, Charlie B Strange⁹

Affiliations

¹ Division of Pulmonary Diseases and Critical Care Medicine and North Carolina Thoracic Society, University of North Carolina at Chapel Hill, Marsico Hall, Room 7202, 125 Mason Farm Rd, Chapel Hill, NC, 27599, USA. pleas005@email.unc.edu.
² Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
³ Pulmonary, Critical Care, Allergy, Immunologic Diseases, Wake Forest University, Winston-Salem, NC, USA.
⁴ UNC at Chapel Hill Division of Pulmonary Diseases and Critical Care Medicine, Chapel Hill, NC, USA.
⁵ Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
⁶ Kentucky Department for Public Health, Frankford, KY, USA.
⁷ Department of Internal Medicine, University of Arizona, Tucson, AZ, USA.
⁸ Department of Medicine, University of Kentucky, Lexington, KY, USA.
⁹ Division of Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.

Abstract

Introduction: Data collected through ongoing, state-based, cross-sectional health surveys could be used to better understand the contribution of respiratory symptoms to impaired health among the US adult population.

Methods: We used the 2015 Behavioral Risk Factor Surveillance System telephone health survey in four states (Kentucky, Florida, South Carolina, Texas) to describe the relationship between symptoms, associated factors such as tobacco smoking, and health impairments. Self-reported productive cough, shortness of breath (SOB), and dyspnea on exertion (DOE) were categorized as minimal, moderate, or severe. Data were analyzed using multiple logistic regression models with age as a covariate to assess relationships of symptoms with other factors.

Results: Among adults ≥ 18 years, respiratory impairment [current asthma, chronic obstructive pulmonary disease (COPD), or a current moderate or severe symptom] occurred in 39.1% of the population. More than half of adults reporting moderate or severe symptoms had not been diagnosed with asthma or COPD, particularly with DOE and productive cough. Subjects were at greater risk of moderate and severe SOB or productive cough with increasing age, prolonged smoking duration (≥ 20 years), being an ever-smoker, or if reporting COPD, current asthma, or any other comorbidity except cancer. Morbid obesity [body mass index (BMI) > 35 kg/m²] was associated with severe DOE at a rate similar to current asthma or COPD (25.6%, 95% CI 20.9-30.3%; 20.8%, 95% CI 16.4-25.1%; 21.3%, 95% CI 17.5-25.1%, respectively); it was the most common cause of DOE. SOB was associated with worse general health impairment and limited ambulation compared with other symptoms. Tobacco smoking prevalence and race varied among states, affecting symptom prevalence.

Conclusion: In the largest US survey in decades, we provide a current perspective of respiratory symptoms among adults of all ages. While known risk factors were apparent, low-risk persons also frequently reported symptoms and impairments.

Keywords: Asthma; Behavioral Risk Factor Surveillance System; COPD; Cross-sectional health survey; Dyspnea on exertion; Obesity; Productive cough; Quality of life; Shortness of breath; Smoking duration.