MRC Scale for Dyspnea Calculator

How does this MRC scale for dyspnea calculator work?

This health tool aims at using the two versions of the Medical Research Council scale in grading the severity of breathlessness. There are 5 items in this MRC scale calculator used to quantify the recurrence and effect of breathlessness in daily activities, especially those that involve a low level of exercise.

The MRC scale goes from no nuisance due to dyspnea in general activities and only a minor disturbance during strenuous exercise to severe breathlessness even in normal situations with an impairment of day to day activities.

The MMRC dyspnea scale is used alongside the BODE Index (the mMRC COPD component) to evaluate the prognostic of patients suffering from chronic obstructive pulmonary disease. This is the version that is nowadays most spread and is used in stratifying patient risk and pulmonary rehabilitation:

■ Grade 0 - I only get breathless with strenuous exercise;

■ Grade 1 - I get short of breath when hurrying on level ground or walking up a slight hill;

■ Grade 2 - On level ground, I walk slower than people of the same age because of breathlessness, or I have to stop for breath when walking at my own pace on the level;

■ Grade 3 - I stop for breath after walking about 100 yards or after a few minutes on level ground;

■ Grade 4 - I am too breathless to leave the house or I am breathless when dressing or undressing.

There have been studies in which the discriminative capacity of the MRC breathlessness scale has been tested, alongside the data from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric classification of COPD. Although each of the assessments has proved high sensitivity separately, taken together they don’t seem to correlate between the stages.

COPD and dyspnea

Chronic obstructive pulmonary disease is characterized by breathlessness, cough (sometimes chronic) and sputum production. Other symptoms include wheezing, chest tightness and sometimes airway irritability. COPD exacerbation represents a stronger infective episode of COPD with an increase in symptom severity and also fatigue and weight loss.

Dyspnea can be defined as the sensation of difficulty in breathing. It needs to be differenced from flow and breathing frequency variations such as tachypnea, hyperventilation, and hyperpnea.

Breathlessness or dyspnea is usually attributed to lack of exercise and low level of fitness but in some cases, it is due to the presence of COPD.

In the following lines there are listed the major factors that cause dyspnea:

■ Heart conditions such as heart attack, congestive heart failure, arrhythmias;

■ Pulmonary conditions such as pneumonia or pulmonary hypertension;

■ Presence of allergies;

■ Gastroesophageal reflux disease;

■ During panic attacks;

■ Chest wall trauma or foreign object inhalation.

The most frequent signs and symptoms of dyspnea include a clearly audible breathing, flaring nostrils, gasping, cyanosis, distressed facial expression and chest protrusion.

Dyspnea on exertion is something that can occur normally but is considered pathological when it occurs at a level of activity that is generally considered as well tolerated or that even the patient used to tolerate.

Orthopnea is breathlessness occurring in recumbent positioning that can only be relieved by turning to a standing or sitting upright position.

Paroxysmal nocturnal dyspnea (PND) occurs at night and awakens the patient and is usually relieved only by an upright position.

References

1) Fletcher CM. (1952) The clinical diagnosis of pulmonary emphysema; an experimental study. Proc R Soc Med; 45(9):577-84.

2) Rhee CK, Kim JW, Hwang YI, Lee JH, Jung KS, Lee MG, Yoo KH, Lee SH, Shin KC, Yoon HK. (2015) Discrepancies between modified Medical Research Council dyspnea score and COPD assessment test score in patients with COPD. Int J Chron Obstruct Pulmon Dis; 10:1623-31.

3) Hsu KY, Lin JR, Lin MS, Chen W, Chen YJ, Yan YH. (2013) The modified Medical Research Council dyspnoea scale is a good indicator of health-related quality of life in patients with chronic obstructive pulmonary disease. Singapore Med J; 54(6):321-7.

4) Mukerji V. Chapter 11: Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea in Walker HK, Hall WD, Hurst JW. (1990) Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.