mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis

Kaisa Rajala; Juho T Lehto; Eva Sutinen; Hannu Kautiainen; Marjukka Myllärniemi; Tiina Saarto

doi:10.1183/23120541.00084-2017

mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis

ERJ Open Res. 2017 Dec 14;3(4):00084-2017. doi: 10.1183/23120541.00084-2017. eCollection 2017 Oct.

Authors

Kaisa Rajala^{1

2}, Juho T Lehto^{3

4}, Eva Sutinen², Hannu Kautiainen^{5

6}, Marjukka Myllärniemi⁷, Tiina Saarto^{1

2}

Affiliations

¹ Helsinki University Hospital, Comprehensive Cancer Center, Dept of Palliative Care, Helsinki, Finland.
² Faculty of Medicine, University of Helsinki, Helsinki, Finland.
³ Dept of Oncology, Palliative Care Unit, Tampere University Hospital, Tampere, Finland.
⁴ Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
⁵ Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.
⁶ Folkhälsan Research Center, Helsinki, Finland.
⁷ University of Helsinki and Helsinki University Hospital, Heart and Lung Center, Dept of Pulmonary Medicine, Helsinki, Finland.

Abstract

This study was undertaken to investigate idiopathic pulmonary fibrosis (IPF) patients' health-related quality of life (HRQoL) and symptoms in a real-life cross-sectional study. Our secondary aim was to create a simple identification method for patients with increased need for palliative care by studying the relationship between modified Medical Research Council (mMRC) dyspnoea scale, HRQoL and symptoms. We sent a self-rating HRQoL questionnaire (RAND-36) and modified Edmonton Symptom Assessment Scale (ESAS) to 300 IPF patients; 84% of the patients responded to these questionnaires. The most prevalent (>80%) symptoms were tiredness, breathlessness, cough and pain in movement. An increasing mMRC score showed a linear relationship (p<0.001) to impaired HRQoL in all dimensions of RAND-36 and the severity of all symptoms in ESAS. Dimensions of RAND-36 fell below general population reference values in patients with mMRC score ≥2. The intensity of pain in movement (p<0.001) and at rest (p=0.041), and the prevalence of chest pain (p<0.001) had a positive linear relationship to increased mMRC score. An increasing mMRC score reflects impaired HRQoL and a high symptom burden. In clinical practice, the mMRC scale could be used for screening and identification of IPF patients with increased need for palliative care.