4.3 Appropriate assessment of dyspnea
Dyspnea is a subjective symptom of physiological distress . A number of tools are available to measure dyspnea in the
clinical and research settings. Two tools nurses use to measure a patient’s present level of dyspnea are the visual analogue
and numeric rating scale. These tools are useful to assess the effectiveness of an intervention such as pharmacotherapy or
position change however; they do not predict what function the patient is capable of or what activities they are avoiding to
prevent dyspnea .
An individual’s usual dyspnea can be assessed using the Medical Research Council Scale (MRC); a simple and valid
method of categorizing patients with COPD in terms of their disability or functional ability. The MRC scale is easy to
administer and requires very little time. It is useful for capturing prolonged changes in dyspnea status. Furthermore,
although there may be changes in pulse rate, blood pressure and respiratory rate of an individual living with COPD, these
changes are not specific to COPD except during acute exacerbation (AECOPD) events or end-stage disease . During
AECOPD, individuals experience incapacitating dyspnea caused by a severe increase in the work of breathing and may
exhibit increased use of accessory muscles. These individuals may also experience alterations in their vital signs .
Changes in the volume, color and viscosity of the sputum may also be present . As the dyspnea worsens, individuals are
less able to complete a full sentence and experience alterations in the level of consciousness. In this guideline we outline
a COPD decision tree to assist nurses an appropriate respiratory assessment