Shortness of breath with moderate exertion is reported by people with multiple sclerosis (32%), but this shortness of breath isn't always due to MS and may be caused by other health issues. Breathing difficulties are reported by 20% of people with MS but are very rare in people who are not dependent on a wheelchair.
What do respiratory problems in multiple sclerosis (MS) feel like? MS-related respiratory problems can take several forms, including:
These are often described as:
Some people with MS first notice breathing problems during sleep. They report that their sleep is disrupted or they awaken feeling anxious, confused and/or with a headache.
(source: http://ms.about.com/od/signssymptoms/a/respiratory_gen.htm)
What do respiratory problems in multiple sclerosis (MS) feel like? MS-related respiratory problems can take several forms, including:
- Shortness of breath
- Difficulty breathing deeply
- Cough
- Frequent sighing
- Not enough air
These are often described as:
- Trying to breathe with a blanket over your head
- Having a heavy weight on the chest
- Inability to take a deep breath
- Anxiety
Some people with MS first notice breathing problems during sleep. They report that their sleep is disrupted or they awaken feeling anxious, confused and/or with a headache.
(source: http://ms.about.com/od/signssymptoms/a/respiratory_gen.htm)
The file below (click on the 'download file') is old (from 2005) but still contains good information
| respiratory_disorders_in_neurologic_diseases1.pdf |
What Causes Breathing/Respiratory Issues in People with MS?
Ironically, the most common cause of respiratory/breathing issues for MS patients has nothing to do with their lungs, but is caused by loss of muscle strength and endurance in the ventilatory muscles of the chest and abdomen that are involved with breathing. Weakness of the ventilatory muscles can begin early in the disease In MS, and just as a person with MS can experience muscle weakness in the arms or legs, weakness can occur in the ventilatory muscles of the chest and abdomen and gradually worsen over time. However, you CAN do something about this.
Ironically, the most common cause of respiratory/breathing issues for MS patients has nothing to do with their lungs, but is caused by loss of muscle strength and endurance in the ventilatory muscles of the chest and abdomen that are involved with breathing. Weakness of the ventilatory muscles can begin early in the disease In MS, and just as a person with MS can experience muscle weakness in the arms or legs, weakness can occur in the ventilatory muscles of the chest and abdomen and gradually worsen over time. However, you CAN do something about this.
Products for Breathing/Respiratory Issues
Inexpensive ($30–70) hand-held devices used to strengthen ventilatory muscles through breathing exercises are readily available and simple to use. Resistive trainers operate by adjusting the aperture of the hole through which one breathes, e.g., Pflex from Respironics or Ultrabreathe from Tangent Pulmonary Function and Rehabilitation (see links below to purchase). While these devices offer resistance to inspiration and expiration, the amount of resistance is altered by the speed at which the client breathes. Thus, one can reduce the level of resistance simply by breathing slower. Without full control of the amount of resistance a device provides, it is difficult to implement a progressive resistance exercise program. A better alternative are the pressure threshold resistance trainers that have spring-loaded valves requiring clients to inspire or expire at specific pressure levels, e.g., Powerbreathe from Gaiam Ltd (see link below). and Threshold IMT from Respironics. The pressure level may be incrementally adjusted to progress a client to higher resistance levels to increase ventilatory muscle strength. These devices are referred to as Threshold IMT (inspiratory) or Threshold EMT (expiratory) devices. (Source: Pulmonary Function, MS Clinical Bulletin, 2013)
Q & A for Breathing/Respiratory Issues in MS
Question from an MS Patient:
I have had MS for 26 years and I haven't ever had problems breathing until this past April. In April, I had a very bad MS flare. Since that time, I have been short of breath and had to see a Pulmonologist who put me on ProAir and Advair. The problem with the Advair is that I cannot really inhale due to muscle weakness and I am wondering if there is another type of medication that I could be put on for maintenance therapy?
Answer/Recommendation:
This type of problem is common and caused by respiratory muscle weakness. While the Proair and Advair may be of benefit they do not solve the underlying problem. The MS society bulletin from 2008 (see link below) clearly summarizes the issues involved. Seeing a pulmonologist in a sleep clinic for a full evaluation and beginning inspiratory and expiratory muscle training using something like the Powerbreathe from Gaiam Ltd. http://www.gaiam.com/powerbreathe-plus/95-1453.html and Threshold IMT from Respironics should be considered. The first is an expiratory muscle trainer and the second is an inspiratory muscle trainer. Both work well and have CPT codes that may allow for insurance coverage. There are many respiratory muscle trainers available and you should discuss these with a pulmonologist who is experience with the kind of problems that either MS or ALS patients experience. You may also benefit from a sleep study to determine if the respiratory muscle weakness is interfering with sleep and increasing daytime fatigue and diminishing daytime performance. If this is the case you might benefit from BiPap (bilevel positive airway pressure).
I have had MS for 26 years and I haven't ever had problems breathing until this past April. In April, I had a very bad MS flare. Since that time, I have been short of breath and had to see a Pulmonologist who put me on ProAir and Advair. The problem with the Advair is that I cannot really inhale due to muscle weakness and I am wondering if there is another type of medication that I could be put on for maintenance therapy?
Answer/Recommendation:
This type of problem is common and caused by respiratory muscle weakness. While the Proair and Advair may be of benefit they do not solve the underlying problem. The MS society bulletin from 2008 (see link below) clearly summarizes the issues involved. Seeing a pulmonologist in a sleep clinic for a full evaluation and beginning inspiratory and expiratory muscle training using something like the Powerbreathe from Gaiam Ltd. http://www.gaiam.com/powerbreathe-plus/95-1453.html and Threshold IMT from Respironics should be considered. The first is an expiratory muscle trainer and the second is an inspiratory muscle trainer. Both work well and have CPT codes that may allow for insurance coverage. There are many respiratory muscle trainers available and you should discuss these with a pulmonologist who is experience with the kind of problems that either MS or ALS patients experience. You may also benefit from a sleep study to determine if the respiratory muscle weakness is interfering with sleep and increasing daytime fatigue and diminishing daytime performance. If this is the case you might benefit from BiPap (bilevel positive airway pressure).
| pulmonaryfunct.ms.clinical.bulletin.2013.pdf |
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