Understanding Breathing Problems with Multiple Sclerosis

A Look at the Breathing Problems That Can Occur with MS

Older woman coughing into her hand
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People with multiple sclerosis (MS) are more likely to have breathing (respiratory) problems along with the well-known symptoms of tingling and numbness, fatigue, the MS hug, and the memory problems. In fact, it's estimated that about 30% of people with MS have decreased respiratory function. In one study, 32% of people with MS reported mild dyspnea (difficulty breathing or shortness of breath) during moderate physical activity.

If you have MS, chances are you score low on pulmonary function tests that assess the strength of the muscles you use to breathe.

What Do MS-Related Breathing Problems MS Feel Like?

Patients who have MS tend to have shallower and faster breathing than those who don’t. This condition is the basis for most MS-related breathing problems, which include:

  • Shortness of breath
  • Difficulty breathing deeply
  • Hiccups
  • Cough
  • Frequent sighing
  • Not enough air

If you have one or more of these breathing problems because of your MS, it may make you feel anxious and as if you:

  • Are trying to breathe with a blanket over your head
  • Have a heavy weight on your chest
  • Are unable to take a deep breath

What Causes Breathing Problems in MS?

It used to be thought that breathing problems in MS first occurred in later stages of the disease. However, it’s now believed that the severity of breathing problems in MS is more closely related to the severity of a person's disease: That is, a person having more (and more severe) MS symptoms and related disability is likely to have more (and more severe) breathing problems.

Breathing problems in MS can be caused by one or more of the following factors:

  • Sensory Problems. MS-related breathing problems may be the result of abnormal respiratory sensory information involving 1) respiratory pressure (abnormal pressure in the lungs), 2) airflow, and 3) motion of the lungs and chest wall.
  • Muscle Weakness. Many people with MS score low on measures of respiratory muscle strength, such as mouth pressure tests. Mouth pressure measures the functioning and strength of respiratory muscles by testing maximum inspiratory (breathing in) pressures and maximum expiratory (exhaling) pressures. These have been shown to be between 60% and 70% of normal even in patients with low MS-related disability.
  • Side-effects of Medications. Some drugs prescribed to help with MS-related pain or spasticity (muscle tightness or stiffness) can cause slower, shallower breathing. These include muscle relaxants, tranquilizers, and opioid-based pain medications.
  • Aspiration Pneumonia. MS-related swallowing difficulties or inability to clear mucus from the nose or throat may lead to aspiration pneumonia, which can occur when liquid, mucus, and/or food particles enter the lungs.

How Severe Can the Breathing Problems Get?

It is extremely rare that MS-related breathing difficulties become life threatening or so severe that the person requires breathing assistance (breathing tubes or supplemental oxygen).

However, even fairly mild breathing problems can cause severe fatigue, further contributing to MS-related fatigue. In addition, the feeling that you can’t get enough air can lead to panic attacks and severe anxiety.

What Help Is Available?

Fortunately, respiratory therapy -- which may include breathing exercises to improve overall respiratory function and prevent respiratory complications during later MS stages -- can be very effective in helping people with the disease breathe more normally.

Tips for Improving Your Breathing

  • Minimize your risk of getting a respiratory infection. Avoid sick people, wash your hands, get your flu shot, and get enough rest. If you start feeling sick, and particularly if you develop a cough, contact your doctor right away.
  • Chew your food slowly and carefully (and avoid laughing hard or talking with your mouth full) to help prevent coughing or choking.
  • If you see a primary care doctor for symptoms of a respiratory infection, tell him or her that you have reduced lung function from MS. This will help ensure that you receive the proper treatment.

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.

Fein A, Kamholz S, Ost D. “Respiratory emergencies.” Hodder Arnold (2006).

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