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

BACKGROUND Methods 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. METHODS One 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. RESULTS Of 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. CONCLUSIONS The 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.

[1]  P. Jones,et al.  Quality of life changes in COPD patients treated with salmeterol. , 1997, American journal of respiratory and critical care medicine.

[2]  C. Roberts,et al.  Arterialised earlobe blood gas analysis: an underused technique. , 1994, Thorax.

[3]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[4]  J E Cotes,et al.  Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[5]  P. O'Byrne,et al.  Is nedocromil sodium effective treatment for asthma? , 1993, The European respiratory journal.

[6]  M. S. Singh,et al.  Development of a shuttle walking test of disability in patients with chronic airways obstruction. , 1992, Thorax.

[7]  N. Jones,et al.  Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. , 1992, The American review of respiratory disease.

[8]  P. Jones,et al.  A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. , 1992, The American review of respiratory disease.

[9]  N B Lincoln,et al.  The Extended Activities of Daily Living scale: a further validation. , 1992, Disability and rehabilitation.

[10]  G. Guyatt,et al.  A measure of quality of life for clinical trials in chronic lung disease. , 1987, Thorax.

[11]  G. Huston.  The Hospital Anxiety and Depression Scale. , 1987, The Journal of rheumatology.

[12]  D. Geddes.  Chronic airflow obstruction. , 1984, Postgraduate medical journal.

[13]  PERCEPTION OF BREATHLESSNESS IN ASTHMA , 1983, The Lancet.

[14]  A. Morgan,et al.  Effect of attitudes and beliefs on exercise tolerance in chronic bronchitis. , 1983, British medical journal.

[15]  M. Artvinli,et al.  Dyspnoea, disability and distance walked: Comparison of estimates of exercise performance in respiratory disease , 1980, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[16]  S. P. Gupta,et al.  Twelve-minute walking test for assessing disability in chronic bronchitis. , 1976, British medical journal.