The document summarizes the mMRC (modified Medical Research Council) scale for measuring breathlessness. It was developed in 1959 based on a study of Welsh coal miners. The mMRC scale ranges from 0-4 and measures the functional impact and limitations caused by breathlessness. It is widely used in research studies to stratify populations and evaluate interventions. While easy to administer, it only measures the impact of breathlessness and not the severity; however, it correlates with quality of life, morbidity, and mortality in respiratory disease patients.

1. mMRC Scale
PHYSIOTHERAPY IN CARDIOPULMONARY CONDITIONS (BPT402)
Submitted To:- Dr. Jamal Ali Moiz
Submitted By:- Nahid
BPT 4th Year
Roll No: 17BPT024
CPRS
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2. Introduction
• The symptom of breathlessness is a common feature of both respiratory and
cardiac problems and is subjective and difficult to quantify.
• To develop a measure of the effect of breathlessness on everyday a study on
pneumoconiosis in Welsh coal miners was performed.
• This was then developed into the familiar Medical Research Council (MRC)
breathlessness/dyspnoea scale and was published in 1959.
• A respiratory questionnaire has also been developed by the MRC and is
published along with guidance for interviewers, the latest version being
published in 1986.
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3. • The mMRC breathlessness scale ranges from grade 0 to 4. It is very similar
to the original version and is now widely used in studies.
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4. Scoring and Interpretation
• The scale on the mMRC dyspnoea scale is very simple, consisting of just
five items containing statements about the impact of breathlessness on the
individual and leading to a grade from 0 to 4.
• It can be self-administered or in format of questions, delivered by a
researcher or clinician.
• Either way it takes seconds to complete.
• It does not grade breathlessness itself but the functional impact of
breathlessness and perceived limitations that result.
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7. Clinical Usage
• The use of the MRC breathlessness scale either on its own or in
combination with other measures is widespread across the world in many
scientific studies. The instrument allows stratification of populations to
assess the effectiveness of interventions. An example is in pulmonary
rehabilitation.
• Researchers such as Bestall et al. found that the scale was a simple and
valid method which could be used to categorize patients with chronic
obstructive pulmonary disease (COPD) in terms of their disability in the
classification of the severity of disease.
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8. Indiations
• Most recent use of the mMRC dyspnoea scale is in COPD patients, its
performance in patients with idiopathic pulmonary fibrosis and sarcoidosis
has also been documented.
• The original MRC breathlessness scale is currently recommended for use in
the diagnosis of patients with COPD by government bodies such as NICE
(National Institute for Health and Care Excellence in England)
• The modified version is a key feature of the GOLD 2011 (Global Initiative
for Chronic Obstructive Airways Disease) recommendations on assessment.
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9. Advantages
• Easy and efficient to calculate.
• Provides a baseline assessment of functional impairment attributable to
dyspnea from respiratory disease.
• Correlates with healthcare-associated quality of life, morbidity, and possibly
mortality for patients with respiratory diseases (particularly COPD).
• Has been used for almost two decades in multiple different heterogeneous
patient populations.
• Correlates with other clinical and research dyspnea indices.
• Inter-rater reliability is very high.
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10. • mMRC dyspnoea scale to assess COPD disability, evaluate quality of life
and provide tailored therapy has been supported across the world.
• Scores are variably associated with patients’ perceptions of respiratory
symptom burden or disease severity (Rennard 2002).
• Scores are associated with morbidity (hospitalization and adverse
cardiovascular outcomes) and, in some studies, mortality.
• Used as a component of the BODE Index, which predicts adverse outcomes,
including mortality and risk of hospitalization (Celli 2004).
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11. • In a study by Jones et al., the modified MRC (mMRC) dyspnoea scale
showed a clear relationship with health status scores and even low mMRC
scores were associated with health impairment
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12. Disadvantages
• The mMRC Dyspnea Scale quantifies disability attributable to
breathlessness, and is useful for characterizing baseline dyspnea in patients
with respiratory diseases.
• Describes baseline dyspnea, but does not accurately quantify response to
treatment of chronic obstructive pulmonary disease (COPD).
• Does not capture patient effort, such that dyspnea from pulmonary disease
(and not behavioral responses to disability) are reflected in mMRC Dyspnea
Scale scores.
• Does not consistently correlate with spirometric measurements (e.g. FEV₁)
for patients with respiratory disease due to COPD.
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13. • Demonstrates at least moderate positive correlation with other dyspnea
scores, including the baseline dyspnea index (BDI) and oxygen cost
diagram (OCD) (Chhabra 2009).
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14. References
• Nerys Williams, The MRC breathlessness scale, Occupational Medicine,
Volume 67, Issue 6, August 2017, Pages 496–497,
https://doi.org/10.1093/occmed/kqx086
• Fletcher CM , Elmes PC , Fairbairn AS , Wood CH . The significance
of respiratory symptoms and the diagnosis of chronic bronchitis in a
working population. Br Med J 1959;2:257–266.
• Rhee CK , Kim JW , Hwang YI 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;10:1623–1631.
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