J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 3, Number 5, October 2011, pages 239-246

Dyspnea as the Reason for Encounter in General Practice

**Table 1.** Patient Distribution* (pd) on Different Age Groups and Consultation Prevalence** (cp) of Dyspnea in Different Age Groups of the German SESAM 2 Study and the Dutch Transition Project Concerning the Condition of New or Previously Known Dyspnea in a General Practice Setting.
Age (years)	SESAM 2 study (n = 93)	Transition Project initial consultation for new occurred dyspnea (n = 3743)	Transition Project subsequent consultation for previously known dyspnea (n = 2747)
Patient distribution (pd) is the percentage of the specified age group of the patients with dyspnea (e.g. 3.23 % of all SESAM 2-patients with dyspnea were 5 to 14 years old); Consultation prevalence (cp) is the percentage of patients with dyspnea in the age group related to all patients of the age group (e.g. among SESAM 2-children from 5 to 14 years of age 1.06% encounter for dyspnea).*There were no patients under age 2 who presented with dyspnea in the SESAM 2 study.
0 to 4	1.08	0.90	12.49	4.8	6.64	2.2
5 to 14	3.23	1.06	7.15	1.9	6.98	1.5
15 to 24	6.45	0.68	7.59	1.8	5.74	1.1
25 to 44	15.05	0.77	24.05	2.0	18.36	1.2
45 to 64	26.88	0.87	22.62	2.5	24.08	1.9
65 to 74	24.73	1.44	13.7	3.2	18.99	3.0
>75	21.51	1.74	12.42	3.1	19.20	3.4

Table 1. Patient Distribution* (pd) on Different Age Groups and Consultation Prevalence** (cp) of Dyspnea in Different Age Groups of the German SESAM 2 Study and the Dutch Transition Project Concerning the Condition of New or Previously Known Dyspnea in a General Practice Setting.

Age (years)

SESAM 2 study (n = 93)

Transition Project initial consultation for new occurred dyspnea (n = 3743)

Transition Project subsequent consultation for previously known dyspnea (n = 2747)

pd (%)

cp (%)

pd (%)

cp (%)

pd (%)

cp (%)

*Patient distribution (pd) is the percentage of the specified age group of the patients with dyspnea (e.g. 3.23 % of all SESAM 2-patients with dyspnea were 5 to 14 years old); **Consultation prevalence (cp) is the percentage of patients with dyspnea in the age group related to all patients of the age group (e.g. among SESAM 2-children from 5 to 14 years of age 1.06% encounter for dyspnea).**There were no patients under age 2 who presented with dyspnea in the SESAM 2 study.

0 to 4

1.08

0.90

12.49

4.8

6.64

2.2

5 to 14

3.23

1.06

7.15

1.9

6.98

1.5

15 to 24

6.45

0.68

7.59

1.8

5.74

1.1

25 to 44

15.05

0.77

24.05

2.0

18.36

1.2

45 to 64

26.88

0.87

22.62

2.5

24.08

1.9

65 to 74

24.73

1.44

13.7

3.2

18.99

3.0

>75

21.51

1.74

12.42

3.1

19.20

3.4

**Table 2.** Physician’s Action (%) in the SESAM 2 Study and the Transition Project Concerning the Condition of New or Already Known Dyspnea. Procedures That Are Not Explicit Diagnostic Were Also Registered in Table 3
Physician's action	SESAM 2 study (n = 93)	Transition Project initial consultation for new occurred dyspnea (n = 3743)	Transition Project subsequent consultation for previously knowndyspnea (n = 2747)
pc: primary care; *sc: specialized care.
Physical examination	93.55	99.48	92.36
Follow-up consultation	84.95	N/A	N/A
EKG	26.88	N/A	N/A
Spirometry	18.28	N/A	N/A
Laboratory investigations	16.13	6.36	5.11
Other diagnostics	13.98	0.27	0.90
Referral	8.60	1.50 (p.c.)*	1.79 (p.c.)*
Anamnesis	4.30	N/A	N/A
Hospitalisation	1.08	3.62 (s.c.)**	5.40 (s.c.)**

Table 2. Physician’s Action (%) in the SESAM 2 Study and the Transition Project Concerning the Condition of New or Already Known Dyspnea. Procedures That Are Not Explicit Diagnostic Were Also Registered in Table 3

Physician's action

SESAM 2 study (n = 93)

Transition Project initial consultation for new occurred dyspnea (n = 3743)

Transition Project subsequent consultation for previously knowndyspnea (n = 2747)

*pc: primary care; **sc: specialized care.

Physical examination

93.55

99.48

92.36

Follow-up consultation

84.95

N/A

EKG

26.88

N/A

Spirometry

18.28

N/A

Laboratory investigations

16.13

6.36

5.11

Other diagnostics

13.98

0.27

0.90

Referral

8.60

1.50 (p.c.)*

1.79 (p.c.)*

Anamnesis

4.30

N/A

Hospitalisation

1.08

3.62 (s.c.)**

5.40 (s.c.)**

**Table 3.** Physician’s Action (%) in the SESAM 2 Study and the Transition Project Concerning the Condition of New or Already Known Dyspnea. Procedures That Are Not Explicitly Therapeutic Were Also Registered in Table 2
Physician's action	SESAM 2 study (n = 93)	Transition Project initial consultation for new occurred dyspnea (n = 3743)	Transition Project subsequent consultation for previously knowndyspnea (n = 2747)
pc: primary care; *sc: specialized care.
Follow-up consultation	84.95	N/A	N/A
Drug prescription	79.57	58.73	63.59
Other therapy	12.90	0.05	0.08
Incapacity to work	11.83	N/A	N/A
Physicians advice	11.83	30.52	28.32
Referral	8.60	1.50 (p.c.)*	1.79 (p.c.)*
Physiotherapy	5.38	N/A	N/A
Long-term care new	4.30	N/A	N/A
Vaccination	2.15	N/A	N/A
Hospitalisation	1.08	3.62 (s.c.)**	5.40 (s.c.)**

Table 3. Physician’s Action (%) in the SESAM 2 Study and the Transition Project Concerning the Condition of New or Already Known Dyspnea. Procedures That Are Not Explicitly Therapeutic Were Also Registered in Table 2

Physician's action

SESAM 2 study (n = 93)

Transition Project initial consultation for new occurred dyspnea (n = 3743)

Transition Project subsequent consultation for previously knowndyspnea (n = 2747)

*pc: primary care; **sc: specialized care.

Follow-up consultation

84.95

N/A

Drug prescription

79.57

58.73

63.59

Other therapy

12.90

0.05

0.08

Incapacity to work

11.83

N/A

Physicians advice

11.83

30.52

28.32

Referral

8.60

1.50 (p.c.)*

1.79 (p.c.)*

Physiotherapy

5.38

N/A

Long-term care new

4.30

N/A

Vaccination

2.15

N/A

Hospitalisation

1.08

3.62 (s.c.)**

5.40 (s.c.)**

**Table 4.** Comparing the Incidence (Number (N) and Percentage (%)) of Results of Encounter (“Diagnoses”) in General Practice Patients With Dyspnea to Those Without Dyspnea (SESAM 2 Study) Shows That Dyspnea Is Significantly Associated to Cardiopulmonary Diseases
Diagnosis*	Dyspnea (n = 93)	Without dyspnea (n = 8784)	p-Value
*Further diagnoses of patients with dyspnea omitted from the table because of lacking significance: acute upper respiratory infection, health maintenance/preventive medicine, oedema, ischaemic heart disease with angina, acute myocardial infarction, atrial fibrillation/flutter, cardiac arrhythmia (not other specified), uncomplicated hypertension, low back symptom/complaint, other osteoarthrosis, sleep disturbance, somatisation disorder, other breathing problem, acute/chronic sinusitis, acute laryngitis/tracheitis, influenza and obesity/overweight.
Acute bronchitis/bronchiolitis	23	24.73	296	3.37	0.000
Other airway diseases	6	6.45	14	0.16	0.000
Heart failure	5	5.38	26	0.30	0.000
COPD	5	5.38	19	0.22	0.000
Bronchial asthma	5	5.38	19	0.22	0.000
Chronic bronchitis	4	4.30	16	0.18	0.000
Dyspnea	4	4.30	2	0.02	0.000
Pneumonia	3	3.23	26	0.30	0.003
Other respiratory infection	1	1.08	3	0.03	0.041
Complaints related to respiratory system organs	1	1.08	2	0.02	0.031

Table 4. Comparing the Incidence (Number (N) and Percentage (%)) of Results of Encounter (“Diagnoses”) in General Practice Patients With Dyspnea to Those Without Dyspnea (SESAM 2 Study) Shows That Dyspnea Is Significantly Associated to Cardiopulmonary Diseases

Diagnosis*

Dyspnea (n = 93)

Without dyspnea (n = 8784)

p-Value

absolute

(%)

absolute

(%)

(Fisher)

*Further diagnoses of patients with dyspnea omitted from the table because of lacking significance: acute upper respiratory infection, health maintenance/preventive medicine, oedema, ischaemic heart disease with angina, acute myocardial infarction, atrial fibrillation/flutter, cardiac arrhythmia (not other specified), uncomplicated hypertension, low back symptom/complaint, other osteoarthrosis, sleep disturbance, somatisation disorder, other breathing problem, acute/chronic sinusitis, acute laryngitis/tracheitis, influenza and obesity/overweight.

Acute bronchitis/bronchiolitis

24.73

296

3.37

0.000

Other airway diseases

6.45

0.16

0.000

Heart failure

5.38

0.30

0.000

COPD

5.38

0.22

0.000

Bronchial asthma

5.38

0.22

0.000

Chronic bronchitis

4.30

0.18

0.000

Dyspnea

4.30

0.02

0.000

Pneumonia

3.23

0.30

0.003

Other respiratory infection

1.08

0.03

0.041

Complaints related to respiratory system organs

1.08

0.02

0.031

**Table 5.** Incidence (%) of the Most Frequent Diagnoses for Primary Care Patients With Complaints of Dyspnea.
Diagnosis	SESAM 2 study (n = 93)	Transition Project initial consultation for new occurred dyspnea (n = 3743)	Transition Project subsequent consultation for previously known dyspnea (n = 2747)
*Further diagnoses of patients with dyspnea omitted from the table because of lacking significance: acute upper respiratory infection, health maintenance/preventive medicine, oedema, ischaemic heart disease with angina, acute myocardial infarction, atrial fibrillation/flutter, cardiac arrhythmia (not other specified), uncomplicated hypertension, low back symptom/complaint, other osteoarthrosis, sleep disturbance, somatisation disorder, other breathing problem, acute/chronic sinusitis, acute laryngitis/tracheitis, influenza and obesity/overweight.
Acute bronchitis	24.73	24.51	9.60
Acute upper respiratory infection	9.68	6.90	0.87
Other airway infection	6.45	0.10	0.05
Bronchial asthma	5.38	10.96	36.12
COPD	5.38	2.19	15.86
Heart failure	5.38	4.09	6.98
Chronic bronchitis	4.30	0.79	5.11
Essential hypertension	4.30	0.25	0.55
Acute shortness of breath/dyspnea	4.30	14.12	4.79
Pneumonia	3.23	2.64	1.03
Acute laryngitis/tracheitis	2.15	3.92	1.00
Prevention/no disease	2.15	1.50	0.16
Ischemic heart disease	2.15	1.23	1.66
Obesity	1.08	0.12	0.08
Back pain	1.08	0.07	0.03
Acute myocardial infarction	1.08	0	0
Acute/chronic sinusitis	1.08	1.78	0.32
Atrial fibrillation/flutter	1.08	0.49	0.79
Influenza	1.08	0.44	0.03
Cardiac arrhythmia	1.08	0.15	0
Oedemata	1.08	0	0
Osteoarthritis	1.08	0	0
Sleep disorder	1.08	0	0
Allergic rhinitis	0	0.57	0.95
Depressive episode	0	0.12	0.21
Pulmonary embolism	0	0.35	0.21
Hyperventilation	0	7.56	4.01
Cough	0	2.05	0.84
Acute stress	0	0.44	0.18
Acute tonsillitis	0	0.35	0.18
Iron deficiency anaemia	0	0.20	0.08
Anxiety disorder	0	0.15	0.37
Malignant respiratory system neoplasm	0	0.12	0.40
Fear of heart attack	0	0.07	0
Stroke	0	0	0.05

Table 5. Incidence (%) of the Most Frequent Diagnoses for Primary Care Patients With Complaints of Dyspnea.

Diagnosis

SESAM 2 study (n = 93)

Transition Project initial consultation for new occurred dyspnea (n = 3743)

Transition Project subsequent consultation for previously known dyspnea (n = 2747)

Acute bronchitis

24.73

24.51

9.60

Acute upper respiratory infection

9.68

6.90

0.87

Other airway infection

6.45

0.10

0.05

Bronchial asthma

5.38

10.96

36.12

COPD

5.38

2.19

15.86

Heart failure

5.38

4.09

6.98

Chronic bronchitis

4.30

0.79

5.11

Essential hypertension

4.30

0.25

0.55

Acute shortness of breath/dyspnea

4.30

14.12

4.79

Pneumonia

3.23

2.64

1.03

Acute laryngitis/tracheitis

2.15

3.92

1.00

Prevention/no disease

2.15

1.50

0.16

Ischemic heart disease

2.15

1.23

1.66

Obesity

1.08

0.12

0.08

Back pain

1.08

0.07

0.03

Acute myocardial infarction

1.08

Acute/chronic sinusitis

1.08

1.78

0.32

Atrial fibrillation/flutter

1.08

0.49

0.79

Influenza

1.08

0.44

0.03

Cardiac arrhythmia

1.08

0.15

Oedemata

1.08

Osteoarthritis

1.08

Sleep disorder

1.08

Allergic rhinitis

0.57

0.95

Depressive episode

0.12

0.21

Pulmonary embolism

0.35

0.21

Hyperventilation

7.56

4.01

Cough

2.05

0.84

Acute stress

0.44

0.18

Acute tonsillitis

0.35

0.18

Iron deficiency anaemia

0.20

0.08

Anxiety disorder

0.15

0.37

Malignant respiratory system neoplasm

0.12

0.40

Fear of heart attack

0.07

Stroke

0.05