The diagnostic and prognostic value of the symptom of shortness of breath in primary care: a cohort study

When a patient consults their GP, the GP may record a symptom (for example, shortness of breath) rather than a diagnosis (for example, asthma) in the patient’s computerised record. This may happen if the GP regards a symptom as mild, or is unsure of the diagnosis at the time of an initial consultation.

Complaints of breathlessness and wheeze are common reasons why patients consult their GP, and may simply be a short-term and minor problem, or alternatively could be an early sign of chronic obstructive pulmonary disease (COPD), asthma, or heart disease. The similarity of symptoms related to these conditions may make their diagnosis from initial symptoms difficult, and often requires a number of tests. This may lead to a delay in diagnosis and in starting appropriate treatment. 

The aim of this study is to assess the outcomes of patients presenting to their GP with symptoms of breathlessness or wheeze for whom a clear diagnosis was not given at that initial consultation. We will use a large, anonymised, high quality database of information recorded during general practice consultations. We will first identify two groups of patients: i) a group with a general practice record of shortness of breath or wheeze symptoms and ii) a group without such a record. We will compare the likelihood of a future diagnosis of COPD, asthma, and heart disease between these two groups and also assess whether those who have a previous recorded breathlessness or wheeze symptom have poorer longer term outcomes such as hospital admission and mortality.

This research will help to improve patient outcomes through assessing whether there is a need for better, and more targeted investigations and management by GPs when they see a patient with a symptom of breathlessness or wheeze for which a diagnosis cannot initially be given.