Initial Evaluation of L-mMRC Severity Tool in Staging COPD in the Skilled Nursing Setting

Background: Older adults with chronic obstructive pulmonary disease (COPD) often experience physical and cognitive changes that complicate diagnosis, medication administration, and management of multiple comorbidities. Clinical assessment is further challenged when tools are not adapted to a patient's level of care, cognitive status, or ambulatory function. The L-mMRC is a novel tool developed by consultant pharmacists in collaboration with skilled nursing facility (SNF) registered nurses. It incorporates long-term care resident self-performance codes for ambulation to provide population-specific COPD staging. Objective: To assess patient COPD ABE GOLD classification using the L-mMRC compared with the mMRC tool or COPD Assessment Test (CAT) score. Methods: This study evaluated the accuracy of the L-mMRC tool in staging COPD among patients in the SNF setting. Participants were SNF residents aged ≥ 65 years with an active COPD diagnosis. Patients with a concurrent diagnosis of asthma or those receiving hospice care were excluded. The primary outcome was the agreement of L-mMRC classifications with mMRC or CAT scores for GOLD staging. Results: Of 283 patients reviewed, 243 met inclusion criteria. The majority of participants were female (68.7%), with a mean age of 79 years. Residents were prescribed between 0 and 6 respiratory medications (mean = 1.2). The mean L-mMRC and CAT scores were 3.04 and 13.17, respectively. Conclusion: Due to the limited availability of baseline CAT and mMRC scores in patient documentation, further evaluation of baseline respiratory status by a pulmonologist or respiratory therapist is needed to validate the accuracy of the L-mMRC tool. These findings also highlight a critical gap in COPD-related care among older adults.