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mMRC (Modified Medical Research Council) Dyspnea Scale

Calculators  Respiratory
mMRC (Modified Medical Research Council) Dyspnea Scale is practical tool utilized to classify the severity of dyspnea in respiratory disease
Symptom severity
Walking should be assessed on level ground
Dyspnea only with strenuous exercise 0
Dyspnea when hurrying or walking up a slight hill 1
Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace 2
Stops for breath after walking 100 yards (91 m) or after a few minutes 3
Too dyspneic to leave house or breathless when dressing 4
Result:

Background

Measured Factor
Severity of dyspnea
Measured Factor Disease
  • Chronic obstructive pulmonary disease
Measured Factor Detail
mMRC (Modified Medical Research Council) Dyspnea Scale is used to assess the degree of baseline functional disability in patients of respiratory disease due to dyspnea. It is employed because it is easy and efficient to calculate. The calculation takes into account on symptom severity of patient.
Speciality
Pulmonologist
Body System
Respiratory
Measured Factor Low Impact
  • Grade 0-2 illustrates low risk of severity
Measured Factor High Impact
  • Grade >3 indicates higher risk severity

Result Interpretation

Ranges Ranges
  • Critical High: >3
Result High Conditions
  • Chronic obstructive pulmonary disease
False Positive
  • Multiple testing
References: 2
Test Limitations
Cutoff point of high symptom is not validated in mMRC score | Does not consistently correlate with spirometric measurements (e.g. FEV₁) for patients with respiratory disease due to COPD.
References: 3

Studies

Study Validation 1
The aim of the study was to validate the use of modified Medical Research Council scale (mMRC scale) in measurement of dyspnea in obese individuals. Further its association with 6-minute walk test (6MWT), lung function and biological parameters was also evaluated. A total of 45 subjects were recruited in the study. mMRC scale was utilized to evaluate the dyspnea in daily living and exeritonal dyspnea was measured by Borg scale after 6MWT. Lung functions tests included plethysmography, spirometry, diffusing capacity of carbon monoxide and arterial blood gases. Subjects were assigned with mMRC scores from 0 to 4. Results showed that 84% of subjects had a mMRC ≥ 1 and 40% had mMRC  ≥ 2. This study concluded that there a significant association of dyspnea in obese subjects confirmed by mMRC scale. mMRC scale is important and effective tool in assessing dyspnea in daily living in obese subjects.
References: 4
Study Validation 2
The objective of this cross-sectional study was to find out any correspondence within the modified Medical Research Council (mMRC) scale and the Baseline Dyspnea Index (BDI) used to assess dypnea. A total of 239 COPD patients were involved in the study and dyspnea was measured by the mMRC scale and the BDI. Correspondence within mMRC and BDI was calculated using Spearman’s correlation coefficient. Results showed that both BDI and mMRC scores were significantly correlated at the group level but not at individual level. Lower FEV1% exacerbation rate, obesity, depression, heart failure, and hyperinflation were some of the variables measured by these scales. This study conclude that mMRC and BDI should be explored separately in patients for measuring dyspnea
References: 5
Study Validation 3
This cross-sectional observational study aimed to compare the performance of the modified Medical Research Council (mMRC) dyspnoea scale and the Global Initiative for Chronic Obstructive Lung Disease (GOLD ) on Health-related quality of life (HRQoL) in COPD patients. HRQoL was evaluated by utilizing the St George's Respiratory Questionnaire (SGRQ) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF A total of 328 patients were involved in the study and their HRQoL scores were compared with both the scales. Results showed mMRC scale was the common factor that remained determinative of HRQol  This study concluded that mMRC scale is clinical effective tool for measuring dysponea in COPD patients
References: 6
Study Additional 1
The prospective study was conducted in 123 patients with COPD with aim to validate the mMRC scale to predict hospitalization and exacerbation in japaneases subjects. Patents were divided into grades ((grades 0 to 4) based on their mMRC scores. Results showed that a score of ≥3 had higher incidence/admissions in hospitals and excaberation. mMRC scale grade of ≥2 showed less displayed  a significantly earlier time until the first exacerbation. This study concluded that score of ≥3 had a very weak prognosis. mMRC scale can be efficiently be used in clinically
References: 7
Study Additional 2
The aim of this study was to validate the two models namely: the Pulmonary Functional Status and Dyspnea Questionnaire - Modified version (PFSDQ-M) and the Medical Research Council (MRC) scale.30 patients with COPD were involved in the study. Both PFSDQ-M and MRC scale were used in calculating the limitations in activities of daily living (ADLs). Results showed there was significant correlation with all the domain. This study validated the reproducibility of the PFSDQ-M and the MRC scale in COPD patients
References: 8

References

  1. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest. 1988;93(3):580-6.
  2. Hersh CP, Demeo DL, Lazarus R, et al. Genetic association analysis of functional impairment in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;173(9):977-84.
  3. Rhee CK, Kim JW, Hwang YI, Lee JH, Jung KS, Lee MG, et al. Discrepancies between modified Medical Research Council dyspnea score and COPD assessment test score in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:1623-31.
  4. Launois C, Barbe C, Bertin E, Nardi J, Perotin JM, Dury S, et al. The modified Medical Research Council scale for the assessment of dyspnea in daily living in obesity: a pilot study. BMC Pulm Med. 2012;12:61.
  5. Perez T, Burgel PR, Paillasseur JL, Caillaud D, Deslée G, Chanez P, et al. Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10:1663-72.
  6. Hsu KY, Lin JR, Lin MS, Chen W, Chen YJ, Yan YH. The modified Medical Research Council dyspnoea scale is a good indicator of health-related quality of life in patients with chronic obstructive pulmonary disease. Singapore Med J. 2013 Jun 1;54(6):321-7.
  7. Natori H, Kawayama T, Suetomo M, Kinoshita T, Matsuoka M, Matsunaga K, et al. Evaluation of the Modified Medical Research Council Dyspnea Scale for Predicting Hospitalization and Exacerbation in Japanese Patients with Chronic Obstructive Pulmonary Disease. Intern Med. 2016;55(1):15-24.
  8. Kovelis D, Segretti NO, Probst VS, Lareau SC, Brunetto AF, Pitta F. Validation of the Modified Pulmonary Functional Status and Dyspnea Questionnaire and the Medical Research Council scale for use in Brazilian patients with chronic obstructive pulmonary disease. J Bras Pneumol. 2008;34(12):1008-18.