April 2019 digital edition

TABLE 1: MRC DYSPNOEA SCALE
Degree of breathlessness related to activities
Not
troubled by
breathlessness
except on
strenuous
exercise
Short of
breath
when
hurrying or
walking up
a slight hill
Walks slower than
contemporaries on level ground
because of breathlessness, or
has to stop for breath when
walking at own pace
Stops for breath after
walking about 100
metres or after a
few minutes on level
ground
Too breathless to
leave the house,
or breathless
when dressing or
undressing
GRADE
1 2 3 4 5
Adapted from Fletcher CM, Elmes PC, Fairbairn MB et al. (1959) The significance of respiratory symptoms and the diagnosis of chronic
bronchitis in a working population. British Medical Journal 2: 257–66.
breathlessness. The Medical Research
Council (MRC) dyspnoea scale (see
table 1) should be used to grade the
breathlessness according to the level of
exertion required to elivcit it.
Spirometry
4. Perform spirometry:
• at diagnosis
• to reconsider the diagnosis, for
people who show an exceptionally
good response to treatment
• to monitor disease progression.
5. Measure post-bronchodilator
spirometry to confirm the diagnosis of
COPD.
6. Think about alternative diagnoses or
investigations for older people who have
an FEV1/FVC ratio below 0.7 but do not
have typical symptoms of COPD.
7. Think about a diagnosis of COPD in
younger people who have symptoms of
SPIROMETRY CAN BE
PERFORMED BY ANY
HEALTHCARE WORKER WHO
HAS HAD APPROPRIATE
TRAINING AND HAS
UP-TO-DATE SKILLS
COPD, even when their FEV1/FVC ratio is
above 0.7.
8. All healthcare professionals who
care for people with COPD should have
access to spirometry and be competent
in interpreting the results.
9. Spirometry can be performed by
any healthcare worker who has had
appropriate training and has up-to-date
skills.
10. Spirometry services should be
supported by quality-control processes.
11. It is recommended that GLI 2012
reference values are used, but it is
recognised that these values are not
applicable for all ethnic groups.
Incidental findings on chest X‐rays or
CT scans
12. Consider primary care respiratory
review and spirometry (see
recommendations 1 to 11 of A) for
people with emphysema or signs of
chronic airways disease on a chest X‐ray
or CT scan.
13. If the person is a current smoker,
their spirometry results are normal and
they have no symptoms or signs of
respiratory disease:
• offer smoking cessation advice and
treatment, and referral to specialist
stop smoking services (see the
April 2019 / FUTURE MEDICINE / 81