The Relationship of Breathlessness with Loneliness in People with Chronic Respiratory Disease: Analysis of data from a nationwide survey

Abstract

Background: Breathlessness is one of the most common and disabling symptoms of chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD), asthma, and interstitial lung disease (ILD). It impacts physical activity, mental health, and quality of life. Loneliness is also related to poor health outcomes, including increased healthcare use, morbidity, and mortality. Qualitative research suggests breathlessness causes loneliness through reducing the quantity and quality of social activities; however, quantitative research is lacking. We hypothesised that breathlessness would be associated with loneliness in people with chronic respiratory diseases. Methods: Using data from the nationwide Asthma + Lung UK “Life with Lung Condition” survey 2025 we analysed the relationship between breathlessness (modified Medical Research Council (mMRC) dyspnoea scale) with loneliness (3-item UCLA Loneliness Scale 3 least lonely to 9 very lonely). We also conducted additional analyses using dichotomised variables (mMRC 0 not breathless and ≥1 indicating breathlessness), and (UCLA loneliness scale 3-5 not lonely and ≥6 lonely). Associations were examined using linear and logistic regression models, adjusted for age, gender, ethnicity, income, and comorbidities.

Results: A total of 6,034 participants (aged ≥18, with chronic respiratory disease) were included in analysis (median age: 67 [58-74] years; 30.9% male; 96.3% White). Increased breathlessness was associated with higher levels of loneliness: (coef: 0.439, 95% CI= 0.39 to 0.48, p <0.001). Results were materially consistent in subgroup analyses of individual conditions including COPD (coef: 0.334, 95% CI= 0.26 to 0.39), asthma (0.447, 95% CI= 0.39 to 0.50), bronchiectasis (0.358, 95% CI= 0.25 to 0.46) and ILD (0. 388 95% CI= 0.23 to 0.54) all with p <0.001) These associations remained significant after adjusting for potential demographic and clinical confounders.

Conclusion: In adults with chronic respiratory disease, increased breathlessness was associated with higher levels of loneliness, suggesting that breathlessness may negatively impact aspects of social wellbeing such as loneliness. These findings highlight the need for holistic management and policy.