SHORTNESS OF BREATH
Not always easy to diagnose, particularly if patient presents with chronic rather than acute symptoms; cause may be cardiac, respiratory or other. Difficulty breathing is called dyspnoea.
- Respiratory causes include: asthma, emphysema, COPD, chest infection
- Cardiac causes include: congestive heart failure
- Other causes include: anaemia, pulmonary embolus, being overweight, being in great pain, anxiety and other emotional problems.
Assessment
Two scales used to assess breathlessness are:
• Modified Medical Research Council (mMRC) Dyspnoea Scale, used in patients with COPD, grading 1-5
• New York Heart Association (NYHA) Functional Classification of Breathlessness, used in patients with heart failure, grading I-IV.
| MODIFIED MRC DSYPNOEA SCALE |
| mMRC Grade 0 |
I only get breathless with strenuous exercise |
| mMRC Grade 1 |
I get short of breath when hurrying on the level or walking up a slight hill |
| mMRC Grade 2 |
I walk slower than people of the same age on the level because of breathlessness, or I have to stop for breath when walking at my own pace on the level |
| mMRC Grade 3 |
I stop for breath after walking about 100 metres or after a few minutes on the level |
| mMRC Grade 4 |
I am too breathless to leave the house or I am breathless when dressing or undressing |
A modified version of the MRC Dyspnoea Scale (mMRC) is recommended in the GOLD COPD guidelines, and is available as an online calculator at https://www.mdcalc.com/mmrc-modified-medical-research-council-dyspnea-scale
| NYHA FUNCTIONAL CLASSIFICATION OF BREATHLESSNESS |
| Class I | No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or dyspnoea |
| Class II | Slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in fatigue, palpitation or dyspnoea |
| Class III | Marked limitation of physical activity. Comfortable at rest but less than ordinary physical activity results in fatigue, palpitation or dyspnoea |
| Class IV | Unable to carry out any physical activity without discomfort. Symptoms at rest. If any physical activity is undertaken, discomfort is increased. |
