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Published on: August 24, 2019
Functional dyspnea as an early marker of vulnerability to persistent physical symptoms in the CONSTANCES
Alexandra Kachaner1, Emmanuel Wiernik2, Sofiane Kab2
1Service de Médecine interne, AP-HP, Hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM UMS 011, "Population-based Cohorts Unit", Paris, France; Unité CASPer, AP-HP, Hôpital Hôtel-Dieu, Paris, France.
Background:
Persistent Physical Symptoms (PPS) are disabling bodily symptoms lasting several months, irrespective of their underlying cause. They share mechanisms with functional disorders, characterized by a mismatch between reported symptoms and objective findings. Functional dyspnea-self-reported shortness of breath in the absence of identifiable cardiopulmonary disease-may represent an early marker of vulnerability to PPS. We investigated whether functional dyspnea assessed before the COVID-19 pandemic was associated with the incidence of PPS during the pandemic.
Methods:
In this population-based study, we included participants from the French CONSTANCES cohort with normal spirometry and no known condition causing dyspnea at inclusion (2012-2019). Functional dyspnea was assessed at inclusion and incident PPS lasting more than 8 weeks were reported during the COVID-19 pandemic, regardless of SARS-CoV-2 infection. Multivariable logistic regression models adjusted for age, sex, body mass index, and educational level were used to estimate the associations.
Results:
Among 17,326 participants (mean age 47.8 years; 54.3% women), 2230 (12.9%) reported functional dyspnea at inclusion. During the pandemic, 6687 participants (39.0%) reported at least one PPS. Functional dyspnea at inclusion was associated with a higher risk of incident PPS (OR 1.79, 95% CI [1.64-1.97], p < 0.001). Results were consistent across sensitivity analyses, including those accounting for SARS-CoV-2 infection. Depressive symptoms and self-rated health explained only a small proportion of the association.
Conclusion:
In this population-based cohort study, functional dyspnea may be a marker of future PPS, supporting the hypothesis of mechanisms common to all PPS, regardless of their type or origin.
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