Staggering cost of breathlessness in Australia revealed

Breathlessness drains at least $12B from the Australian economy every year in direct health and productivity costs, and people living with the condition are more likely to be unemployed and have diminished quality of life, according to new research from The George Institute for Global Health published in the Medical Journal of Australia.

The study of more than 10,000 Australian adults is the first to calculate accurately the compound societal burden of health care expenses and working days lost to breathlessness from any cause. For those with severe breathlessness, the report shows the impact on quality of life is on a par with lung cancer.

Shortness of breath (“dyspnea”) that is not associated with strenuous exercise affects people diagnosed with multiple conditions, including chronic obstructive pulmonary disease (COPD, which includes emphysema and chronic bronchitis), lung cancer, silicosis, asthma and heart disease, as well as obesity, anxiety, and depression. Others may have no diagnosed disease.

“While many studies have looked at the impact on quality of life and productivity of diseases known to cause breathlessness, like COPD or lung cancer, none that we are aware of have explored these economic and social costs in all populations, including people that have no other disease,” said lead author Dr. Anthony Sunjaya, a Research Fellow in the Respiratory Program at The George Institute for Global Health and UNSW Sydney.

Researchers estimate the total population living with breathlessness is estimated to be 10% of adult Australians, a prevalence that is likely to increase due to negative impacts on cardiopulmonary health (heart, vascular and lung systems) from increasing obesity, air pollution, and climate-induced weather events such as bushfire and dust-storms.

“The results are shocking enough but they are conservative: the data predates COVID-19 and its high respiratory burden, and we did not factor in children, who have increasing rates of asthma and obesity, and are also going to be impacted by future climate-related events as much as adults,” Dr. Sunjaya explained.

“We found severe breathlessness is associated with greater unemployment, but the economic calculations don’t allow us to capture the additional income losses this represents, nor productivity losses from ‘presenteeism’ for people at work but not able to perform at full capacity,” he said.

The study found:

• The estimated total annual health care use cost for breathlessness is $11.1 billion per annum
• The total societal cost (adding in productivity losses) is $12.2 billion per annum
• 10% respondents had clinically significant breathlessness
• Almost three quarters of these (73.7%) were under 65 years, with a mean age of just 43
• Anxiety was the most common comorbidity
• People with the most severe breathlessness were 70% more likely to be unemployed than those with mild (not clinically relevant) breathlessness
• Women with breathlessness plus two or more chronic conditions (multimorbidity) were associated with lower employment compared to men with the same level of severity
• People with breathlessness are twice as likely to need an annual urgent GP visit and two to three times more likely to need frequent (more than six per annum) GP or specialist interactions

“Most people with breathlessness receive care from GPs, so we clearly need to strengthen capacity in primary care to manage this debilitating symptom, especially as other studies have reported patients can be dissatisfied with their GP’s care, and that many GPs themselves feel ill equipped,” Dr. Sunjaya said.

Harry Patsamanis, General Manager of Consumer Programs and Partnerships at Lung Foundation Australia, says improved policy and health services for people with breathing difficulties is needed.

“We see firsthand how people with breathlessness cannot do things the rest of us take for granted, simple things like walking up a flight of stairs, gardening, going shopping or exercising, let alone function effectively in a full-time job. People describe it as an invisible disability where their world becomes smaller, and their pain and anxiety are often dismissed or stigmatized,” said Patsamanis.

“People can adjust and find ways to live life, provided they are given the tools and support to do so. Other countries are much better at recognizing that this symptom requires treatment and support regardless of its cause. And that means providing better education and resources for primary and allied health care professionals, as well as increasing awareness so that people seek help,” he said.

The Lung Foundation has recently released a resource called the Lung Learning Hub, designed to educate GPs on the diagnosis and management of breathlessness.

“It is vital we identify potential solutions to improve quality of life for people with breathlessness, even when a causal diagnosis is yet to be made,” said Dr. Sunjaya. “Implementing new models of care to improve timely access to health care and reduce the severity of breathlessness early may facilitate people to return to or stay in the workforce, which would reduce the massive societal impact.”