Dyspnea as the Reason for Encounter in General Practice

BACKGROUND: Dyspnea is a common reason for consulting a physician. Data from the primary care setting on the epidemiology, management, and underlying causes of dyspnea have seldomly been published. The present study is aimed to explore the consultation prevalence of dyspnea, frequency of diagnostic and therapeutic procedures, accompanying symptoms and results of encounter or diagnoses of patients with dyspnea in a day-to-day primary care setting. METHODS: Cross-sectional data were collected from randomly selected patients during the SESAM 2 study (October 1, 1999 to September 30, 2000). Unpublished but publicly available data from the Dutch Transition Project were also analysed. RESULTS: One (n = 93; SESAM 2) and 3.9% (n = 7,855; Transition Project) of the patients consulted the practioner for dyspnea. The male to female ratio was almost 1 : 1. Half of the patients sought medical advice for not previously known dyspnea (Transition Project). Dyspnea occurs more frequently among small children (0 to 4 years) and elderly adults (> 64 years of age). Nearly all patients received a physical examination. Many causes were examined with the help of electrocardiograms but spirometry and laboratory tests were also used. Drug prescription was the most frequent (79.6%) therapeutic procedure. Acute bronchitis was the most common diagnosis. Dyspnea was significantly associated to cough, dysphagia, abnormal sputum, airway pain, sweating, and thoracic pain. There was also a significant association to chronic obstructive pulmonary disease. CONCLUSIONS: Dyspnea is a common reason for seeking medical advice. Emergency cases (e.g. myocardial infarction) are rarely present in the general practitioner’s consultation. The majority of underlying causes are respiratory tract infections and exacerbated, previously known chronic diseases. KEYWORDS: Dyspnea; General practice; Primary care; Reason for encounter