Prevalence and impacts of breathlessness in South Africa: an exploratory, cross-sectional population study

Background: Chronic breathlessness contributes substantially to the global health burden and healthcare use, yet data on its prevalence and impacts in lower-resource settings remain limited. We investigated the prevalence, self-reported underlying conditions, and impacts of breathlessness at the population level in South Africa. Methods: We conducted a cross-sectional online survey in English among community-dwelling adults aged 18 years or older. The sample was stratified by age, sex, and rurality to reflect the 2022 National Census. Self-reported data included sociodemographic characteristics; breathlessness, assessed using the modified Medical Research Council (mMRC) breathlessness scale; employment; activities of daily living, assessed using an item from the London Chest Activities of Daily Living; quality of life, assessed using the EQ-5D-5L and EQ visual analogue scale; and disability, assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0. We analysed the weighted dataset using descriptive statistics. Results: We included 2,828 respondents with a mean age of 37.1 years (standard deviation = 12.4), of whom 52.3% were female. Clinically important breathlessness (mMRC ≥ 2) was reported by 189 respondents (6.7%), with a median duration of 3.1 years (interquartile range = 1.5-5.4). The most commonly reported attributions were lung conditions other than tuberculosis (23.8%), 'other' factors (16.4%), and anaemia (11.6%). Clinically important breathlessness was associated with poorer perceived health, lower quality of life, and higher total disability scores than mild (mMRC 1) or no breathlessness (mMRC 0). Mobility and participation were the most affected disability domains. Among respondents with an mMRC≥2, 64 (33.8%) reported an impact on employment, of whom 49 (76.6%) had ceased full-time work, while 171 (90.3%) respondents reported an impact on daily activities. Conclusions: We estimate that more than four million people in South Africa live with clinically important breathlessness. The symptom is associated with poorer quality of life, greater disability, reduced employment, and impaired function. The life-changing effects of this debilitating symptom among community-dwelling adults should be investigated in longitudinal studies to help inform clinical policy and practice.