A simple dyspnoea scale as part of the assessment to predict outcome across chronic interstitial lung disease

Background and objective The Medical Research Council dyspnoea score ( MRCDS ) is a simple, objective scale to assess dyspnoea, the main complaint in patients with chronic interstitial lung disease ( ILD ). We sought to investigate whether MRCDS is a predictor of outcome in patients with chronic ILD . Methods One hundred and fifteen patients (50 idiopathic pulmonary fibrosis ( IPF ) and 65 non‐ IPF ILD ) were retrospectively studied. Baseline (time of diagnosis) MRCDS and 3–6‐month changes were considered. Endpoints were (i) 18‐month clinical progression, defined as either: ≥10% absolute reduction in forced vital capacity ( FVC ) percent predicted; ≥50‐m decline in 6‐min walk distance; hospitalization for respiratory causes; lung transplantation ( LTx ) assessment or death and (ii) 18‐month survival. Results At the end of the observation period, 54 subjects (47%) experienced clinical progression (including 22 deaths and 3 LTx ). In patients with IPF , a longitudinal increase in MRCDS predicted clinical progression significantly (area under the curve ( AUC ) = 0.76, sensitivity = 62%, specificity = 91%); baseline MRCDS was a strong predictor of mortality ( AUC  = 0.80, sensitivity = 87%, specificity = 57%). In patients with non‐ IPF ILD , longitudinal increases in MRCDS , but not baseline values, were predictive of both clinical progression ( AUC  = 0.81, sensitivity = 85%, specificity = 77%) and mortality ( AUC  = 0.76, sensitivity = 91%, specificity = 61%). Considering the whole population, MRCDS increase and FVC decline were independent predictors of mortality. Conclusion Longitudinal increases of MRCDS predict poor outcome in chronic ILD , with good accuracy. Baseline MRCDS remains a strong predictor of mortality in IPF . MRCDS should be included in the global assessment of the clinical course of chronic ILD .