Thorax 1999;54:581-586 ( July )

Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease

J C Bestall^b, E A Paul^a, R Garrod^a, R Garnham^a, P W Jones^b, J A Wedzicha^a

^a Academic Department of Respiratory Medicine, St Bartholomew's and Royal London School of Medicine and Dentistry, London Chest Hospital, London, UK, ^b Division of Physiological Medicine, St George's Hospital Medical School, London SW17 0RE, UK

Correspondence to: Professor P Jones.

Received 23 March 1998; Returned to authors 4 June 1998; Revised version received 21 December 1998; Accepted for publication 15 February 1999

BACKGROUNDMethods of classifying chronic obstructive pulmonary disease (COPD) depend largely upon spirometric measurements but disability is only weakly related to measurements of lung function. With the increased use of pulmonary rehabilitation, a need has been identified for a simple and standardised method of categorising disability in COPD. This study examined the validity of the Medical Research Council (MRC) dyspnoea scale for this purpose.
METHODSOne hundred patients with COPD were recruited from an outpatient pulmonary rehabilitation programme. Assessments included the MRC dyspnoea scale, spirometric tests, blood gas tensions, a shuttle walking test, and Borg scores for perceived breathlessness before and after exercise. Health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Questionnaire (CRQ). The Nottingham Extended Activities of Daily Living (EADL) score and Hospital Anxiety and Depression (HAD) score were also measured.
RESULTSOf the patients studied, 32 were classified as having MRC grade 3 dyspnoea, 34 MRC grade 4 dyspnoea, and 34 MRC grade 5 dyspnoea. Patients with MRC grades 1 and 2 dyspnoea were not included in the study. There was a significant association between MRC grade and shuttle distance, SGRQ and CRQ scores, mood state and EADL. Forced expiratory volume in one second (FEV₁) was not associated with MRC grade. Multiple logistic regression showed that the determinants of disability appeared to vary with the level of disability. Between MRC grades 3 and 4 the significant covariates were exercise performance, SGRQ and depression score, whilst between grades 4 and 5 exercise performance and age were the major determinants.
CONCLUSIONSThe MRC dyspnoea scale is a simple and valid method of categorising patients with COPD in terms of their disability that could be used to complement FEV₁ in the classification of COPD severity.


Keywords: MRC dyspnoea scale; chronic obstructive pulmonary disease; dyspnoea

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© 1999 by Thorax
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