Breathing Difficulties In MS

1. Breathing, or respiration is controlled by the autonomic or ‘automatic’ nervous system. This is the part of the central nervous system (CNS) which controls vital functions such as heartbeat and breathing without conscious thought.

However, it is rare for MS to affect the autonomic nervous system, and therefore uncommon for breathing problems to happen as a direct result of loss of this autonomic control. If a breathing problem happens suddenly, it is of the utmost importance to seek medical help immediately.

Serious breathing difficulties only affect a minority of MS patients who become very severely disabled. In addition to contributing to feelings of fatigue, breathing problems can also interfere with the process of speech and voice production.

2. Another cause of breathing difficulties can be as result of aspiration pneumonia. This results from the inability to clear mucus or saliva from the nose and throat, or from swallowing difficulties that result in inhalation of food, water even, into the lungs. A swallowing evaluation will generally help patients who repeatedly take food into their lungs. Sometimes, a feeding tube is necessary to avoid continued risk of aspiration pneumonia.

3. Some medications commonly used for MS symptoms such as tranquilisers, muscle relaxants, and opioid analgesics, can depress the breathing mechanism. The use of these medications should be monitored in anyone who is suffering from breathing problems.

4. Muscle weakness: as the muscles which control breathing weaken, the ability to cough is impaired and the patient is at a high risk of pneumonia and other complications in the lungs. Inactivity can result in such weakness, as can poor postural alignment and trunk control, muscle imbalances, decreased bone density, and/or shallow, inefficient breathing.

5. Many people with MS are on Disease Modifying Drugs such as Glacitamer Acetate (Copaxone ®) and the Beta-Interferons (Rebif® and Avonex®). These can, but only rarely, cause a severe allergic reaction. It is advised that a person with MS calls their doctor if they develop hives, skin rash with irritation, dizziness, sweating, chest pain or trouble breathing.

How are breathing difficulties managed or treated?

People with MS who have difficulty breathing due to weakness of chest muscles can often benefit from:

• Breathing exercises and devices that encourage deep breathing
• Sitting upright (rather than lying flat);
• Chest percussion, which involves tapping lightly on the chest to loosen secretions.
• Breathing techniques. A therapist can teach breathing exercises to improve the efficiency of the lungs, therefore a doctor may refer a person to a specialist for an evaluation of the lungs and breathing.
• Proper seating and support. A physical or occupational therapist can recommend changes and aids to make breathing less tiring. For example, changing from a manual wheelchair to a powered wheelchair can do a lot to ease breathing-related fatigue. Switching from a chair with a soft back to one with lumbar support can also help. Sitting upright instead of slumped often makes breathing easier.
• One rather obvious way of easing things for those who smoke cigarettes or pipe tobacco is to stop, because smoking puts a strain on the lungs, making fatigue worse and compounding the effects of MS.
• Other treatments may include gentle chiropractic techniques to rebalance the muscles; also yoga in which a person is trained to control breathing and to breathe deeply.

Personal Experiences

“I’ve never really had any problems with my lungs nor my breathing so it came as a bit of a shock, and a scary one at that, when I discovered my breathing was becoming more difficult. The build up to this episode was purely down to fatigue. I quite often get sleepy, probably as a combined effect of the MS and side effects of some of the pills I take. However over a period of a few weeks my fatigue was becoming more severe and would last all day and short naps were doing nothing to alleviate it. During this period I noticed that my breathing was becoming more difficult, it just felt like more of an effort. The best way I can describe it is like trying to breathe whilst permanently having a duvet over your head. Fortunately this episode didn’t last long and once my fatigue eased a bit my breathing was perfectly normal again.”

“The only breathing difficulties I ever get are when I get the 'MS Hug' ....it's so tight that I can't expand my ribcage enough to breathe properly so keep trying unsuccessfully to take deep breaths. I believe that I should be doing the opposite like people who suffer asthma and take shorter, shallow breaths through my nose until it has passed”

© Multiple Sclerosis Resource Centre (MSRC)