The prevalence of persisting breathlessness despite treatment in chronic conditions

Breathlessness impairs all aspects of daily life and places substantial burden on healthcare systems. This review explores the prevalence of breathlessness that persists despite optimal treatment in chronic conditions. Defining its scale is essential to ensure recognition and provision of evidence-based, breathlessness-specific interventions alongside disease management. Despite advances in breathlessness management research over the past decade, persistent breathlessness remains unacceptably common, reflecting implementation gaps and limited access to effective therapies.

Recent systematic reviews report breathlessness in 35-87% of people with cancer, with episodic breathlessness affecting up to 80% of those with persistent symptoms. Across primary studies in COPD, asthma, pulmonary fibrosis, pulmonary vascular and neurological conditions, and cancer, prevalence ranges from 9% to 91%. Even among people receiving guideline-based disease treatment, 38-53% report clinically relevant breathlessness. The mMRC dyspnea scale may underestimate prevalence compared with exercise testing and multidimensional questionnaires.

Persistent breathlessness remains common across major chronic diseases, often despite optimal disease therapy. Clinicians across all sectors of healthcare should routinely ask people about their breathlessness, and evidence-based strategies should be offered as part of routine, integrated symptom management to help reduce the high burden of persistent breathlessness in clinical populations.