Coughing and Shortness of Breath as Symptoms of MS
Just when you thought that the tingling
and numbness, the fatigue, the MS
hug and the memory problems were enough,
turns out that people with multiple
sclerosis (MS) are prone to respiratory problems,
as well. In fact, most of us would test pretty low on pulmonary function tests
designed to assess the strength of our respiratory muscles.
Fortunately, for most of
us, these problems are not noticeable or do not impede us in any significant
way. Even better, it turns out there may be exercises that we can do to prevent
this from getting worse.
Respiratory Problems in MS Feel Like?
MS-related respiratory problems can take
several forms, including:
Shortness of breath
Difficulty breathing deeply
Not enough air
These are often described
Trying to breathe with a blanket over your head
Having a heavy weight on the chest
Inability to take a deep breath
Common Are MS-Related Respiratory Problems?
Breathing difficulties are reported by 20% of
people with MS. In one study, 32% of people with MS reported mild dyspnea
(painful breathing or shortness of breath) under moderate exertion.
Causes Respiratory Problems in People with MS?
It has long been thought that respiratory
problems occur later in the disease process. However, recent studies fail to
correlate these symptoms with duration of MS. Rather it is the severity of MS
(disability levels) that is a good indication of how severe the breathing
difficulties will be. Breathing difficulties in MS can be caused by one or more
of the following factors:
Sensory Problems It is
now thought that these symptoms may be the result of abnormal respiratory
Muscle Weakness: Many
people with MS score low on measures of respiratory muscle strength, such as
mouth pressure tests (see below).
Side Effect of Medications: Some
drugs prescribed to help with MS-related pain or spasticity can cause breathing
to be slower and shallower. These include muscle relaxants, tranquilizers and
opioid-based pain medications.
Aspiration Pneumonia: This
is caused when food particles, liquid or mucus enters the lungs. This can be a
cause of breathing difficulties in people with MS, due to MS-related swallowing
difficulties or inability to clear mucus from nose or throat.
Severe Can It Get?
It is extremely rare that
MS-related breathing difficulties become so severe as to require breathing
assistance (breathing tubes or supplemental oxygen) or become life-threatening.
However, even fairly mild breathing problems can cause severe fatigue, further
contributing to other sources of MS-related
fatigue. In addition, the feeling that you can’t get
enough air can lead to panic attacks and severe anxiety.
“Panting” and MS: Patients
with MS tend to have a more superficial (shallower) and faster breathing rate
than people in the general population.
Lower Mouth Pressure: Mouth
pressure is a measure to assess the functioning and strength of respiratory
muscles by testing maximum inspiratory (breathing in) pressures and maximum
expiratory (exhaling) pressures. These were found to be between 60 and 70% of
normal even in patients with low disability (EDSS scores of 1.5 to 5.0).
Respiratory Therapy: Breathing
exercises to prevent respiratory complications during later stages of MS as
well as improve overall respiratory function appears to be successful at
improving breathing capacity.
Although I have not had my respiratory function
formally evaluated, I am pretty sure that it is impaired. The way that it
manifests itself for me is that whenever I get an infection that is accompanied
by coughing, I will continue to cough for a long time, even after the infection
has passed. Coughs that should be “productive,” meaning bringing up mucus, just
don’t seem to clear out my throat and chest like they should. I just have this
constant hacking, which sometimes turns into a big coughing fit – often making
me feel like I am on the verge of passing out. Eventually, the cough will pass,
but even physicians are surprised at how long this takes and how resistant the
cough is to different remedies or supressants.
I also need to chew
slowly and carefully, as I can set off a coughing/choking spell if I talk or
laugh too much when eating. I have also noticed that it doesn’t take much
exertion on the treadmill or going up stairs to get me winded, which I had
previously attributed to simply being out of shape. My lack of fitness probably
does play a big part of feeling winded, but it just seems out of proportion to
how hard it is to catch a breath sometimes.
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By Julie Stachowiak, Ph.D.
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