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MRC Grade


It is clinically helpful to assess breathlessness using MRC grading of 1 to 5. This is a validated measure of disease severity irrespective of patient’s FEV1. 

MRC Grade Symptoms

Grade 1


Not troubled by breathlessness except on strenuous exercise.

Grade 2


Short of breath when hurrying, or walking up a slight hill.

Grade 3


Walks slower than contemporaries on level ground because of breathlessness, or have to stop for breath when walking at own pace

Grade 4


Stops for breath after walking about 100 metres or after a few minutes on level ground.

Grade 5


Too breathless to leave the house or breathless when dressing or undressing.

Grade 3 and above - offer referral to Pulmonary Rehabilitation. 

Click here for Pulmonary Rehabilitation referral form, and here for Pulmonary Rehabilitation patient information leaflet.  


These items have high impact for assessing health status, irrespective of spirometry results.

Worsening of any of these signs or symptoms indicate a red flag and the patient should be referred to the GP where further treatment should be considered.

Symptoms Further information
 MRC Grade


 MRC is a validated measure of disease severity (irrespective of patient’s FEV1). It is also used to determine eligibility for Pulmonary Rehab service (those with an MRC Grade of 3, 4 or 5 can be referred).


 Frequent exacerbations


 There will be impact on treatment if patient is experiencing 2 or more exacerbations in a 12 month period. (An exacerbation is generally classed as a deterioration in symptoms from baseline requiring change in treatment)


 Unintentional Weight Loss


 A low BMI can impact on lung function, may indicate underlying cancer, and is an independent predictor of mortality. Patients with COPD sometimes find it difficult to eat due to breathing difficulties and/or choking on some food.


 Worsening oedema


 May indicate chronic hypoxia and heart failure




 COPD patients are at high risk of developing lung cancer.




 May indicate worsening breathing problems


 Sleep Disturbance


 Medication, sleep position and sleep-related breathing changes can cause COPD patients to have disturbed sleep. Identifying sleep disturbance may result in medication changes (including prescribing oxygen or changing the dosage of bronchodilator therapy).


 Oedema or ankle swelling


 Swelling of legs, feet and ankles may indicate the development of pulmonary hypertension.