This page will help you to assess the impact of your patient’s COPD symptoms and determine what treatment plan is right for them.
Evidence shows that the severity of an individual's airway obstruction doesn't necessarily reflect the effect that COPD has on their life. So it’s important that you use validated assessment tools to measure the impact of the condition.
Here you will find a variety of assessment tools that will help you to undertake a holistic assessment of your patients', which takes into consideration symptoms, quality of life and exacerbation risk.
GOLD (2026) recommends starting off by assessing the impact breathlessness has on your patient using the Modified Medical Research Council Dyspnoea scale (mMRC) or the COPD assessment tool (CAT).
Breathlessness assessment
The Modified Medical Research Council Dyspnoea Scale grades the severity of dyspnoea (breathlessness) on a scale from 0 to 4, with higher scores indicating more severe breathlessness.
| Description | Grade |
|---|---|
| I only get breathless with strenuous exercise | 0 |
| I get short of breath when hurrying on level ground or walking up a slight hill | 1 |
| On level ground, I walk slower than people of my age because of breathlessness, or I have to stop for breath when walking at my own pace on the level | 2 |
| I stop for breath after walking about 100 yards or after a few minutes on level ground | 3 |
| I am too breathless to leave the house or I am breathless when dressing/undressing | 4 |
The Borg Dyspnoea Scale allows your patient to rate their perceived exertion during activity.
Patient instruction:
“This is a scale that asks you to rate the difficulty of your breathing. It starts at number 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal. How much difficulty is your breathing causing you right now?”
|
Numeral |
Perceived exertion rating |
|---|---|
| 0 | No exertion |
| 0.5 | Noticeable |
| 1 | Very light |
| 2 | Light |
| 3 | Moderate |
| 4 | Somewhat difficult |
| 5 | Difficult |
| 6 | |
| 7 | Very difficult |
| 8 | |
| 9 | Almost maximal |
| 10 | Maximal |
The Borg RPE scale (R) ((C) Gunnar Borg, 1970, 1998, 2017). Scale printed with permission.
The BORG scale is often used in walking distance tests, such as the 6-minute walk test or shuttle test. These tests allow you to monitor your patient's breathlessness on exertion, their response to pulmonary rehabilitation and provide information about whether they need to be referred for oxygen assessment.
Another option for exercise testing is the One-Minute Sit to Stand Test. PCRS have produced a protocol for this test, which can be used in primary care. It can be easily conducted in a patient's home or a small clinic room, requires minimal equipment, is quick to perform, and provides valuable insights into your patient’s physiological response to exercise.
Health status assessment
Health status assessments provide information about the impact that COPD is having on your patient's life and daily activities. They should be completed at diagnosis and every subsequent review, whether that be their annual review or a post exacerbation review.
The COPD Assessment Tool (CAT) is a patient-completed questionnaire consisting of eight items, each addressing a different aspect of the patient's health related to COPD, including cough, phlegm, chest tightness, breathlessness, activity limitation, confidence, sleep, and energy levels.
Each item is rated from 0 (no impact) to 5 (severe impact). The scores for all eight items are added together to give a total score between 0 and 40.
A score of less than 10 suggests a lower burden of symptoms
A score of more than 10 suggests a higher burden of symptoms
Please read the guide to the CAT before using it with your patients.
Next, review your patient’s notes to identify any exacerbations they’ve had over the past year. This is important as even one moderate or severe exacerbation increases the risk of future events:
• Moderate exacerbations are episodes requiring treatment with systemic corticosteroids and/or antibiotics in addition to increased bronchodilator use.
• Severe exacerbations are those that require hospitalisation or an emergency department visit.
Gold (2026) recommends that you should now combine the CAT and mMRC with the number of exacerbations and categorise your patient using the ABE assessment tool.
The GOLD ABE assessment tool
The GOLD ABE tool helps you assess COPD severity and future risk by bringing together spirometry, symptoms and exacerbation history. It is designed to support your treatment decisions, not replace your clinical judgement
© 2026, Global Initiative for Chronic Obstructive Lung Disease, available from www.goldcopd.org, published in Deer Park, IL, USA.
Resources for your patient
A diagnosis of COPD can be distressing. Offer your patient our First steps to living with COPD booklet and signpost them to our Helpline, where our specialist nurse and healthcare advisors are available to talk things through with your patient, and explore any social and practical difficulties they might have.
Don’t forget our helpline is here to support HCPs as well. Call and speak with our supportive respiratory nurse specialists if you have questions or worries about diagnosing, treating or supporting your patients with a lung condition.