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Wednesday, January 1, 2014

Respiratory Problems in People with Multiple Sclerosis

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.
What Do Respiratory Problems in MS Feel Like?
MS-related respiratory problems can take several forms, including:
·         Shortness of breath
·         Difficulty breathing deeply
·         Hiccups
·         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
How 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.
What 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 sensory information.
·         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.
How 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.
Additional Points/Information
“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.
My Experience
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.
Sources:
Rae-Grant AD, Eckert NJ, Bartz S, Reed JF. Sensory symptoms of multiple sclerosis: a hidden reservoir of morbidity. Mult Scler. 1999 Jun;5(3):179-83.
Gosselink R, Kovacs L, Decramer M. Respiratory muscle involvement in multiple sclerosis. Eur Respir.1999; 13: 449-54.
Mutluay FK, Gürses HN, Saip S. Effects of multiple sclerosis on respiratory functions. Clin Rehabil. 2005 Jun;19(4):426-32.
 Article written 
By Julie Stachowiak, Ph.D.

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