MRC Dyspnoea Scale in COPD

Chronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction that is usually progressive, not fully reversible and does not change markedly over several months. The diagnosis is suspected on the basis of symptoms (particularly breathlessness or cough) and signs, and supported by spirometry.

  • In the early stages, COPD may produce minimal or no symptoms.
  • Opportunistic case finding should be based on the presence of risk factors (age and smoking) and symptoms. The diagnosis should be confirmed using spirometry
  • As the disease progresses, the symptoms in individual patients vary.
  • Individual symptoms in isolation are not useful in excluding or making the diagnosis of COPD.
  • A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with one or more of the following symptoms
  • Exertional breathlessness
  • Chronic cough
  • Regular sputum production
  • Frequent winter 'bronchitis'
  • Wheeze
  • Patients in whom a diagnosis of COPD is considered should also be asked about the presence of the following factors: weight loss, effort intolerance, waking at night, ankle swelling, fatigue.
The Medical Research Council (MRC) dyspnoea scale should be used to grade the level of breathlessness:
  • Not troubled by breathlessness except on strenuous exercise.
  • Short of breath when hurrying or walking up a slight hill.
  • Walks slower than contemporaries on level ground because of breathlessness or has to stop for breath when walking at own pace.
  • Stops for breath after walking about 100 m or after a few minutes on level ground.
  • Too breathless to leave the house, or breathless when dressing or undressing.