Table 1

eMRCD score, guidance note for eMRCD and DECAF score

eMRCD score ‘In the past 3 months, when you were feeling at your best, which of the following statements best describes your level of breathlessness?’		(Circle)
Only breathless on strenuous exertion		1
Breathless hurrying on the level or walking up a slight hill		2
Walks slower than contemporaries, or stops after walking on the level for 15 min		3
Stops for breath after walking 100 m, or for a few minutes, on the level		4
Too breathless to leave the house unassisted but independent in washing and/or dressing		5a
Too breathless to leave the house unassisted and requires help with washing and dressing		5b
Guidance notes: Remember that you are asking the patient about their level of breathlessness on a good day over the preceding 3 months, not breathlessness during an exacerbation/on admission. A patient only achieves a higher grade if they are as breathless as defined in that higher grade. ▸ eg, if worse than defined in eMRCD 3, but not as bad as eMRCD 4, they remain eMRCD 3. A key distinction is between eMRCD 4 and eMRCD 5a/5b: ▸ only score 5a or 5b if the patient cannot leave the house without assistance. ▸ if a patient can only walk 30 to 40 metres, but can leave the house unassisted, they are eMRCD 4. ▸ if a patient can walk 5 or 10 metres, perhaps from their front door to a car, but need a wheelchair otherwise, they require assistance: eMRCD 5a or 5b. Simple walking aids do not constitute assistance. If a patient requires assistance in personal washing and dressing they are eMRCD 5b. If they only require assistance in washing or dressing they are eMRCD 5a. Remember to ask about putting on socks and shoes. If patients are limited for a reason other than breathlessness, score based on their functional limitation.

DECAF Score		Circle
D	eMRCD 5a (Too breathless to leave the house unassisted but independent in washing and/or dressing) eMRCD 5b (Too breathless to leave the house unassisted and requires help with washing and dressing)	1 2
E	Eosinopenia (eosinophils <0.05×10⁹/L)	1
C	Consolidation	1
A	Moderate or severe acidaemia (pH <7.3)	1
F	atrial Fibrillation (including history of paroxysmal atrial Fibrillation)	1
Total

eMRCD, extended Medical Research Council dyspnoea score.