Question From an MS Patient About Breathing

Question of the Week:
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 http://thresholdimt.respironics.com/ 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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