Breathing problems worsen along with MS disability, study finds

Breathing problems are common in advanced multiple sclerosis (MS), becoming more frequent as disability increases, according to a study by researchers in London.

“Screening for respiratory dysfunction can be easily incorporated into routine clinical care by asking about respiratory symptoms,” they wrote.

The study, “Respiratory dysfunction in people with advanced multiple sclerosis,” was published in Multiple Sclerosis and Related Disorders.

MS is an autoimmune disease that damages nerve cells in the brain and spinal cord, causing difficulty walking and maintaining balance, swallowing problems, fatigue, and chronic pain. Over time, patients may also experience difficulty breathing, particularly if the disease has caused disability.

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Review of medical records shows extent of problems

To find out how often breathing problems occur in advanced MS and how they are managed during regular care, the researchers reviewed the medical records of 105 adults with MS who had severe disability, defined as an Expanded Disability Status Scale (EDSS) score of 8 or higher. In the EDSS, a higher score indicates more severe disability.

Of the 105 patients, 64 (61%) had at least one breathing problem, and about two-thirds (67%) of these had two or more. Symptoms included hypophonia (a weak or unusually quiet voice), a weak cough, difficulty breathing, difficulty clearing mucus from the airways, recent chest infections, and sleep apnea, which occurs when breathing repeatedly stops during sleep.

Some symptoms could have more than one cause. For example, a weak voice may result from weak muscles involved in breathing, speech, or swallowing. Seven patients could not be tested for phonation (the production of sound by the vocal cords) because they had difficulty producing speech or understanding language.

Swallowing problems were also very common. About two-thirds of patients (65.7%) reported dysphagia (difficulty swallowing). Nineteen (18.1%) had either had a gastrostomy — a procedure that creates an opening to deliver food directly into the stomach when swallowing is difficult — or were awaiting one.

Breathing problems became more common as disability increased. Among patients with an EDSS score of nine or higher, most (94%) had breathing problems. Many (76%) received or were referred for respiratory care. “Respiratory dysfunction is very common in people with advanced [MS] and increases with higher EDSS,” the researchers wrote.

In total, 47 people (44.8%) received respiratory interventions or were referred for them. Many were also referred to speech and language therapy for problems with speech or swallowing, although these referrals were not counted as respiratory treatments because they could address multiple symptoms.

Eight patients died during the study, at a mean age of 56, and the cause of death was known for seven of them. Five of those seven deaths (71%) were caused by respiratory infections or their complications.

“There is a clear need for further research and guidance in the assessment and management of respiratory dysfunction due to multiple sclerosis,” the researchers concluded. However, they added, “this may be constrained by a lack of respiratory services.”