Occupational Medicine 2008 58(3):226-227; doi:10.1093/occmed/kqm162
© The Author 2008. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
The MRC breathlessness scale
Chris Stenton
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Brief history
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Breathlessness is a complex subjective sensation that is an
important feature of cardio-respiratory disease. It is difficult
to quantify but it is necessary to do that if the symptoms of
a particular group are to be summarized and compared with others.
Fletcher and co-workers addressed this problem when studying
the respiratory problems of Welsh coal miners at the Medical
Research Council Pneumoconiosis Unit in the 1940s. They devised
a short questionnaire that allowed a numeric value to be placed
on each subject's exercise capacity. The questions were first
published in 1952 [
1] and rapidly developed into the MRC breathlessness
scale [
2]. They have been in widespread use since then.
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Description
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The MRC breathlessness scale (
Figure 1) comprises five statements
that describe almost the entire range of respiratory disability
from none (Grade 1) to almost complete incapacity (Grade 5).
It can be self-administered by asking subjects to choose a phrase
that best describes their condition, e.g. ‘I only get
breathless with strenuous exertion’ (Grade 1) or ‘I
am too breathless to leave the house’ (Grade 5). Alternatively,
it can be administered by an interviewer with the statements
framed as questions, e.g. ‘Are you short of breath when
hurrying on the level or walking up a slight incline’
(Grade 2). The score is the number that best fits the patient's
level of activity. All the questions relate to everyday activities
and are generally easily understood by patients. A score can
usually be obtained in a few seconds.
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Validity
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The MRC breathlessness scale does not quantify breathlessness
itself. Other tools such as the Borg scale or visual analogue
scales are used for that [
3]. Rather, it quantifies the disability
associated with breathlessness by identifying that breathlessness
occurs when it should not (Grades 1 and 2) or by quantifying
the associated exercise limitation (Grades 3–5).
There is up to 98% agreement between observers recording MRC breathlessness scores [4]. The score correlates well with the results of other breathlessness scales, lung function measurements [4] and with direct measures of disability such as walking distance [3]. Its main disadvantage over other more complex scales is its relative insensitivity to change. Changes can be demonstrated, for example, after lung surgery [5] but it is uncommon for individuals to improve or deteriorate by an entire grade over relatively short periods. There are no precise limits to several of the grades and this might contribute to the insensitivity to change: an individual who can leave the house but walk <100 yards does not clearly fall into either Grade 4 or Grade 5.
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Key research
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The MRC breathlessness scale is widely used to describe patient
cohorts and stratify them for interventions such as pulmonary
rehabilitation in COPD [
6]. It can predict survival [
7] and
it is advocated as complementary to FEV
1 in describing disability
in those with COPD [
8]. It is not subject to copyright and is
widely available for clinical and research work. In >50 years
of use it has certainly demonstrated its worth.
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References
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- Fletcher CM. The clinical diagnosis of pulmonary emphysema—an experimental study. Proc R Soc Med (1952) 45:577–584.[Web of Science][Medline]
- Fletcher CM, Elmes PC, Fairbairn MB, et al. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J (1959) 2:257–266.[Free Full Text]
- American Thoracic Society. Dyspnea Mechanisms, assessment, and management: a consensus statement. Am J Respir Crit Care Med (1999) 159:321–340.[Free Full Text]
- Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest (1988) 93:580–586.[CrossRef][Web of Science][Medline]
- Ciccone AM, Meyers BF, Guthrie TJ, et al. Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema. J Thorac Cardiovasc Surg (2003) 125:513–525.[Abstract/Free Full Text]
- Wedzicha JA, Bestall JC, Garrod R, Garnham R, Paul EA, Jones PW. Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale. Eur Respir J (1998) 12:363–369.[Abstract]
- Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest (2002) 121:1434–1440.[CrossRef][Web of Science][Medline]
- Bestall C, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax (1999) 54:581–586.[Abstract/Free Full Text]
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