Dyspnea Scale
Name
First Name
Last Name
Email
example@example.com
Treatment Status
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Pre-Treatment
Post-Treatment
Number of weeks on treament
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Modified Medical Research Council Dyspnoea Scale
“I only get breathless with strenuous exercise”
“I get short of breath when hurrying on the level or walking up aslight hill”
“I walk slower than people of the same age on the level becauseof breathlessness or have to stop for breath when walking at myown pace on the level”
“I stop for breath after walking about 100 yards or after a fewminutes on the level”
“I am too breathless to leave the house” or “I am breathlesswhen dressing”
Doherty DE et al. COPD: Consensus Recommendations for early diagnosis and treatment. Journal ofFamily Practice, Nov 2006
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