Dyspneais the medical term used to describe shortness of breath, a symptom considered central to all forms ofchronic obstructive pulmonary disease (COPD)including emphysema and chronic bronchitis.
As COPD is both a progressive and non-reversible, the severity of dyspnea plays a key role in determining both the stage of the disease and the appropriate medical treatment.
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Challenges in Diagnosis
From a clinical standpoint, the challenge of diagnosing dyspnea is that it is very subjective. Whilespirometrytests (which measures lung capacity) andpulse oximetry(which measures oxygen levels in the blood) may show that two people have the same level of breathing impairment, one may feel completely winded after activity while the other may be just fine.
Ultimately, a person’sperceptionof dyspnea is important as it helps ensure the person is neither undertreated nor overtreated and that the prescribed therapy, when needed, will improve the person’s quality of life rather than take from it.
To this end, pulmonologists will use a tool called the modified Medical Research Council (mMRC) dyspnea scale to establish how much an individual’s shortness of breath causes real-world disability.
How the Assessment Is Performed
The process of measuring dyspnea is similar to tests used to measure pain perception in persons with chronic pain. Rather than defining dyspnea in terms of lung capacity, the mMRC scale will rate the sensation of dyspnea as the person perceives it.
The severity of dyspnea is rated on a scale of 0 to 4, the value of which will direct both the diagnosis and treatment plan.
GradeDescription of Breathlessness0"I only get breathless with strenuous exercise.“1"I get short of breath when hurrying on level ground or walking up a slight hill.“2"On level ground, I walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace.“3"I stop for breath after walking about 100 yards or after a few minutes on level ground.“4"I am too breathless to leave the house, or I am breathless when dressing.“Role of the MMRC Dyspnea ScaleThe mMRC dyspnea scale has proven valuable in the field of pulmonology as it affords doctors and researchers the mean to:Assess the effectiveness of treatment on an individual basisCompare the effectiveness of a treatment within a populationPredict survival times and ratesFrom a clinical viewpoint, the mMRC scale correlates fairly well to such objective measures aspulmonary function testsandwalk tests. Moreover, the values tend to be stable over time, meaning that they are far less prone to subjective variability that one might assume.Using the BODE Index to Predict SurvivalThe mMRC dyspnea scale is used to calculate theBODE index, a tool which helps estimate the survival times of people living with COPD.The BODE Index is comprised of a person’sbody mass index(“B”), airway obstruction (“O”), dyspnea (“D”), and exercise tolerance (“E”). Each of these components is graded on a scale of either 0 to 1 or 0 to 3, the numbers of which are then tabulated for a final value.The final value—ranging from as low as 0 to as high as 10—provides doctors a percentage of how likely a person is to survive for four years. The final BODE tabulation is described as follows:0 to 2 points: 80 percent likelihood of survival3 to 4 points: 67 percent likelihood of survival5 of 6 points: 57 percent likelihood of survival7 to 10 points: 18 percent likelihood of survivalThe BODE values, whether large or small, are not set in stone. Changes to lifestyle and improved treatment adherence can improve long-term outcomes, sometimes dramatically. These include things likequitting smoking,improving your dietandengaging in appropriate exerciseto improve your respiratory capacity.In the end, the numbers are simply a snapshot of current health, not a prediction of your mortality. Ultimately, the lifestyle choices you make can play a significant role in determining whether the odds are against you or in your favor.
Role of the MMRC Dyspnea Scale
The mMRC dyspnea scale has proven valuable in the field of pulmonology as it affords doctors and researchers the mean to:
From a clinical viewpoint, the mMRC scale correlates fairly well to such objective measures aspulmonary function testsandwalk tests. Moreover, the values tend to be stable over time, meaning that they are far less prone to subjective variability that one might assume.
Using the BODE Index to Predict Survival
The mMRC dyspnea scale is used to calculate theBODE index, a tool which helps estimate the survival times of people living with COPD.
The BODE Index is comprised of a person’sbody mass index(“B”), airway obstruction (“O”), dyspnea (“D”), and exercise tolerance (“E”). Each of these components is graded on a scale of either 0 to 1 or 0 to 3, the numbers of which are then tabulated for a final value.
The final value—ranging from as low as 0 to as high as 10—provides doctors a percentage of how likely a person is to survive for four years. The final BODE tabulation is described as follows:
The BODE values, whether large or small, are not set in stone. Changes to lifestyle and improved treatment adherence can improve long-term outcomes, sometimes dramatically. These include things likequitting smoking,improving your dietandengaging in appropriate exerciseto improve your respiratory capacity.
In the end, the numbers are simply a snapshot of current health, not a prediction of your mortality. Ultimately, the lifestyle choices you make can play a significant role in determining whether the odds are against you or in your favor.
3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Janssens T, De peuter S, Stans L, et al.Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program.Chest.2011;140(3):618-625. doi:10.1378/chest.10-3257Manali ED, Lyberopoulos P, Triantafillidou C, et al.MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study.BMC Pulm Med. 2010;10:32. doi:10.1186/1471-2466-10-32Esteban C, Quintana JM, Moraza J, et al.BODE-Index vs HADO-score in chronic obstructive pulmonary disease: Which one to use in general practice?.BMC Med. 2010;8:28. doi:10.1186/1741-7015-8-28Additional ReadingChhabra, S., Gupta, A., and Khuma, M. “Evaluation of Three Scales of Dyspnea in Chronic Obstructive Pulmonary Disease.“Annals of Thoracic Medicine.2009; 4(3):128-32. DOI:10.4103/1817-1737.53351.Perez, T.; Burgel, P.; Paillasseur, J.; et al. “Modified Medical Research Council scale vs Baseline Dyspnea Index to Evaluate Dyspnea in Chronic Obstructive Pulmonary Disease.“International Journal of Chronic Obstructive Pulmonary Disease. 2015; 10:1663-72. DOI:10.2147/COPD.S82408.
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Janssens T, De peuter S, Stans L, et al.Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program.Chest.2011;140(3):618-625. doi:10.1378/chest.10-3257Manali ED, Lyberopoulos P, Triantafillidou C, et al.MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study.BMC Pulm Med. 2010;10:32. doi:10.1186/1471-2466-10-32Esteban C, Quintana JM, Moraza J, et al.BODE-Index vs HADO-score in chronic obstructive pulmonary disease: Which one to use in general practice?.BMC Med. 2010;8:28. doi:10.1186/1741-7015-8-28Additional ReadingChhabra, S., Gupta, A., and Khuma, M. “Evaluation of Three Scales of Dyspnea in Chronic Obstructive Pulmonary Disease.“Annals of Thoracic Medicine.2009; 4(3):128-32. DOI:10.4103/1817-1737.53351.Perez, T.; Burgel, P.; Paillasseur, J.; et al. “Modified Medical Research Council scale vs Baseline Dyspnea Index to Evaluate Dyspnea in Chronic Obstructive Pulmonary Disease.“International Journal of Chronic Obstructive Pulmonary Disease. 2015; 10:1663-72. DOI:10.2147/COPD.S82408.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Janssens T, De peuter S, Stans L, et al.Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program.Chest.2011;140(3):618-625. doi:10.1378/chest.10-3257Manali ED, Lyberopoulos P, Triantafillidou C, et al.MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study.BMC Pulm Med. 2010;10:32. doi:10.1186/1471-2466-10-32Esteban C, Quintana JM, Moraza J, et al.BODE-Index vs HADO-score in chronic obstructive pulmonary disease: Which one to use in general practice?.BMC Med. 2010;8:28. doi:10.1186/1741-7015-8-28
Janssens T, De peuter S, Stans L, et al.Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program.Chest.2011;140(3):618-625. doi:10.1378/chest.10-3257
Manali ED, Lyberopoulos P, Triantafillidou C, et al.MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study.BMC Pulm Med. 2010;10:32. doi:10.1186/1471-2466-10-32
Esteban C, Quintana JM, Moraza J, et al.BODE-Index vs HADO-score in chronic obstructive pulmonary disease: Which one to use in general practice?.BMC Med. 2010;8:28. doi:10.1186/1741-7015-8-28
Chhabra, S., Gupta, A., and Khuma, M. “Evaluation of Three Scales of Dyspnea in Chronic Obstructive Pulmonary Disease.“Annals of Thoracic Medicine.2009; 4(3):128-32. DOI:10.4103/1817-1737.53351.Perez, T.; Burgel, P.; Paillasseur, J.; et al. “Modified Medical Research Council scale vs Baseline Dyspnea Index to Evaluate Dyspnea in Chronic Obstructive Pulmonary Disease.“International Journal of Chronic Obstructive Pulmonary Disease. 2015; 10:1663-72. DOI:10.2147/COPD.S82408.
Chhabra, S., Gupta, A., and Khuma, M. “Evaluation of Three Scales of Dyspnea in Chronic Obstructive Pulmonary Disease.“Annals of Thoracic Medicine.2009; 4(3):128-32. DOI:10.4103/1817-1737.53351.
Perez, T.; Burgel, P.; Paillasseur, J.; et al. “Modified Medical Research Council scale vs Baseline Dyspnea Index to Evaluate Dyspnea in Chronic Obstructive Pulmonary Disease.“International Journal of Chronic Obstructive Pulmonary Disease. 2015; 10:1663-72. DOI:10.2147/COPD.S82408.
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