Evaluation of the Modified Medical Research Council Dyspnea Scale for Predicting Hospitalization and Exacerbation in Japanese Patients with Chronic Obstructive Pulmonary Disease

Abstract

Objective The modified Medical Research Council (mMRC) scale is recommended for conducting assessments of dyspnea and disability and functions as an indicator of exacerbation. The aim of this study was to investigate whether the mMRC scale can be used to predict hospitalization and exacerbation in Japanese patients with chronic obstructive pulmonary disease (COPD). Methods In a previous 52-week prospective study, 123 patients with COPD were classified into five groups (grades 0 to 4) according to the mMRC scale and four groups (stages I to IV) according to the spirometric Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The frequency and period until the first event of hospitalization and exacerbation were compared among the groups. Results The population of patients who experienced hospitalization and exacerbation during the 52-week study period, with an mMRC scale grade of 4, 3, 2, 1 and 0 was 50.0 and 100, 55.6 and 88.9, 21.1 and 73.7, 2.6 and 48.7, and 4.0 and 22.0%, respectively. A multivariate analysis adjusted for the GOLD stage and age showed that the patients with an mMRC scale grade of ! 3 had higher frequencies of hospitalization and exacerbation than those with lower grades. Meanwhile, the patients with an mMRC scale grade of ! 2 showed a significantly earlier time until the first exacerbation, but not hospitalization, in comparison with those with grade 0. Conclusion The present results indicate that, among Japanese patients with COPD, those with an mMRC scale grade of ! 3 have a significantly poorer prognosis and that the mMRC scale can be used to predict hospitalization and exacerbation.

Chronic bronchitis is associated with severe exacerbation and prolonged recovery period in Chinese patients with COPD: a multicenter cross-sectional study

“…In a large United Kingdom population, mMRC score is associated with experience of severe exacerbations requiring hospitalization (29). In a prospective study of 123 Japanese patients with COPD, mMRC score ≥3 is an independent risk factor of frequency of exacerbation and hospitalization (30). Our data were consistent with these previous studies.…”

Understanding low COPD exacerbation rates in Japan: a review and comparison with other countries

“… 10 – 18 In general, COPD severity appeared to account for much of the variability, with exacerbation rates varying according to GOLD classification and modified Medical Research Council grade. 11 , 13 For studies that assessed the whole COPD population, without respect to COPD severity, exacerbation rates ranged 0.24–0.8 events per year. 10 , 12 , 14 , 15 , 17 , 18 Interestingly, in the Kitano cohort study, which aimed to improve inhaler technique and adherence, exacerbation rates decreased from 1.5 at baseline to 0.8 by Year 4.…”

Copd

“…This scale is considered as a selfreported questionnaire and is therefore useful for estimating dyspnea. 22 In the present study we used MRC Dyspnea Scale for predicting exacerbation in patients. In the present study Bode Index Score was used for estimating each of the following variables (FEV1 (% of predicted); Distance walked in 6 mins (m); MMRC Dyspnea Scale and BMI).…”