Functional dyspnea as an early marker of vulnerability to persistent physical symptoms in the CONSTANCES population-based cohort

Alexandra Kachaner; Emmanuel Wiernik; Sofiane Kab; Marie Zins; Antoine Duclos; Thierry Perez; Nicolas Roche; Rachel Nadif; Clément Gouraud; Victor Pitron; Omer Van den Bergh; Brigitte Ranque; Cédric Lemogne

doi:10.1016/j.jpsychores.2026.112887

Functional dyspnea as an early marker of vulnerability to persistent physical symptoms in the CONSTANCES population-based cohort

J Psychosom Res. 2026 Jun 1:209:112887. doi: 10.1016/j.jpsychores.2026.112887. Online ahead of print.

Authors

Affiliations

¹ Service 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. Electronic address: Alexandra.kachaner@aphp.fr.
² Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM UMS 011, "Population-based Cohorts Unit", Paris, France.
³ Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM UMS 011, "Population-based Cohorts Unit", Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France.
⁴ CHU de Lille, Service de Pneumologie et Immuno-allergologie, Service d'Explorations Fonctionnelles Respiratoires, Univ. Lille, CNRS, Inserm, CHU Lille, Lille, France; Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France.
⁵ Service de Pneumologie, AP-HP Centre, Hôpital Cochin, Paris, France; Université Paris Cité, UMR 1016, Institut Cochin, Paris, France.
⁶ Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Paris, France.
⁷ Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France.
⁸ Université Paris Cité, VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France; Centre du Sommeil et de la Vigilance-Pathologie professionnelle, APHP, Hôtel-Dieu, F-75004 Paris, France.
⁹ Health Psychology, University of Leuven, Leuven, Belgium.
¹⁰ Service de Médecine interne, AP-HP, Hôpital européen Georges-Pompidou, Paris, France; Unité CASPer, AP-HP, Hôpital Hôtel-Dieu, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France.
¹¹ Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France.

PMID: 42247774
DOI: 10.1016/j.jpsychores.2026.112887

Abstract

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.

Keywords: COVID-19; Functional dyspnea; Persistent physical symptoms.