Medical Research Council (MRC) Dyspnea Scale

The Medical Research Council (MRC) Dyspnea Scale is a simple and widely used tool to assess the level of breathlessness experienced by a patient during daily physical activity. It’s most often used for patients with chronic respiratory diseases like COPD (Chronic Obstructive Pulmonary Disease), interstitial lung disease, asthma, or post-cardiac surgery.

It uses a 5-point scale (Grades 1 to 5) the higher the grade, the more severe the dyspnea (difficulty breathing).

MRC Dyspnea Scale:

Grade 1 – No or minimal dyspnea

“I only get breathless with strenuous exercise.”

• Patient can carry out normal activities like walking, climbing stairs, household chores without breathlessness.

• Typically not restricted in lifestyle.

• Often seen in early disease stages or very fit individuals.

Suggested Exercises/Advice:

• Regular aerobic activity (e.g., brisk walking, cycling)

• Breathing exercises like pursed-lip breathing

• Maintain a healthy lifestyle

Grade 2 – Mild dyspnea

“I get short of breath when hurrying on the level or walking up a slight hill.”

• May start limiting speed or avoiding hills.

• Noticed in moderate activity, but still independent.

• Can often still participate in most activities with mild self-pacing.

Suggested Exercises/Advice:

• Interval walking: walk-rest-walk pattern

• Start low-intensity pulmonary rehab

• Focus on posture correction and energy conservation

Grade 3 – Moderate dyspnea

“I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace.”

• Breathlessness affects daily living like walking, going to the market, or doing chores.

• May begin avoiding social outings or outdoor activity.

• Often indicative of moderate to severe lung limitation.

Suggested Exercises/Advice:

• Supervised pulmonary rehabilitation

• Diaphragmatic breathing training

• Teach use of pacing strategies

• Resistance training for limb strength

Grade 4 – Severe dyspnea

“I stop for breath after walking about 100 meters or after a few minutes on the level.”

• Can walk short distances but has to pause frequently.

• May need help carrying bags or doing routine chores.

• Can trigger anxiety due to breathlessness.

Suggested Exercises/Advice:

• Chair-based exercises

• Use of walking aids with oxygen support (if prescribed)

• Anxiety reduction techniques (e.g., Benson’s Relaxation, mindfulness)

Grade 5 – Very severe dyspnea

“I am too breathless to leave the house or I am breathless when dressing or undressing.”

• Breathless at rest or with minimal activity.

• Activities like brushing hair, dressing, or even talking can be exhausting.

• May be homebound or bedbound.

Suggested Exercises/Advice:

• Bed mobility and gentle limb range exercises

• Positioning for breath relief (leaning forward)

• Active cycle of breathing technique (ACBT)

• Regular reassessment and caregiver training

Clinical Use of the MRC Scale

• Quick to administer takes less than a minute.

• Good screening tool for respiratory conditions.

• Helps track disease progression or rehab improvement.

• Often used in combination with objective measures like spirometry, 6-minute walk test, or oxygen saturation levels.

Reliability and Validity

Reliability:

• The MRC scale has shown good test–retest reliability, meaning it consistently yields similar results when administered multiple times to the same individuals under similar conditions.

• In a study by Bestall et al. (1999), test–retest reliability was high in patients with COPD.

Validity:

• Construct Validity: The MRC scale correlates significantly with other measures of disease severity, such as: (i) FEV₁ (Forced Expiratory Volume in 1 second), (ii) 6-minute walk test (6MWT), and (iii) Health-related quality of life measures (e.g., St. George’s Respiratory Questionnaire).

• Criterion Validity: MRC grades align well with clinical judgments of disability due to dyspnea. It predicts mortality and hospitalization risk in chronic respiratory disease patients.

• Responsiveness: While useful for assessing baseline disability, the MRC scale is less sensitive to small changes over time compared to multi-item questionnaires like the Borg Scale or Modified Medical Research Council (mMRC) Dyspnea Scale.

References:

1. Paladini, L., Hodder, R., Cecchini, I., Bellia, V., & Incalzi, R. A. (2010). The MRC dyspnoea scale by telephone interview to monitor health status in elderly COPD patients. Respiratory medicine, 104(7), 1027–1034. https://doi.org/10.1016/j.rmed.2009.12.012

2. Bestall, J. C., Paul, E. A., Garrod, R., Garnham, R., Jones, P. W., & Wedzicha, J. A. (1999). Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax, 54(7), 581–586. https://doi.org/10.1136/thx.54.7.581

3. Manali, E. D., Lyberopoulos, P., Triantafillidou, C., Kolilekas, L. F., Sotiropoulou, C., Milic-Emili, J., Roussos, C., & Papiris, S. A. (2010). MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study. BMC pulmonary medicine, 10, 32. https://doi.org/10.1186/1471-2466-10-32

4. Nouraei, S. A., Nouraei, S. M., Randhawa, P. S., Butler, C. R., Magill, J. C., Howard, D. J., & Sandhu, G. S. (2008). Sensitivity and responsiveness of the Medical Research Council dyspnoea scale to the presence and treatment of adult laryngotracheal stenosis. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, 33(6), 575–580. https://doi.org/10.1111/j.1749-4486.2008.01832.x