MDF Magazine Issue 62 7 August 2020 (7)

Breathing Problems
Healthy
By Vijaya Iyer
Muscular Dystrophy News Today
In muscular dystrophy, progressive weakness of respiratory
muscles can result in varying degrees of breathing difficulty.
One of the most important respiratory muscles is the
diaphragm, which sits just below the lungs and helps in the
process of inhalation, or breathing in, which supplies oxygen
to the lungs. The weakening of the diaphragm in people with
muscular dystrophy results in reduced oxygen intake and
decreased lung function.
Different muscles help in exhalation, or removal of carbon
dioxide. Contraction of muscles in the abdomen during
activity supports exhalation, while at rest, lung elasticity
aides in the removal of carbon dioxide. In muscular
dystrophy patients, the excessive workload on the lungs, due
to poor diaphragm function and the weakening of abdominal
muscles, hinders the elimination of carbon dioxide.
Weakness in the muscles of the upper respiratory tract, or
the nose and throat, causes difficulty breathing during sleep.
This makes muscular dystrophy patients, therefore, prone to
breathing problems while they are sleeping.
Respiratory muscles also support coughing, and their
breakdown causes coughing difficulties.
Scoliosis, or the abnormal curvature of the spine, affects
the structure of the chest wall, which also can contribute to
breathing problems.
Symptoms
Monitoring breathing and coughing ability are vital for
people with muscular dystrophy to support the early
identification and management of breathing problems.
Symptoms of breathing problems in MD patients include:
• Shallow breathing and snoring
• Difficulty sleeping
• Wheezing
• Shortness of breath, especially at rest
• A cold that lasts for more than 10 days
• Morning headaches
• Daytime sleepiness
Testing
When breathing problems are suspected, a trained pulmonologist
may perform a series of tests to determine the strength
of respiratory muscles to perform their function. These tests
include:
• Pulmonary function tests that are usually performed in
children over age 5
• Sleep studies to determine nighttime breathing patterns
• Pulse oximetry to measure oxygen levels in the blood
Treatment and management
The treatment plan to address breathing problems in people
with muscular dystrophy is based on the breathing symptoms
observed.
Children with muscular dystrophy are prone to respiratory
infections such as pneumonia. Therefore, it is recommended
that they receive pneumonia vaccination as a preventive
measure. For acute respiratory infections, antibiotic therapy
is prescribed.
Chest physiotherapy in consultation with trained respiratory
therapists, and the use of assistive devices such as vests, can
help in clearing mucus, and prevent recurrent infections.
Bronchodilators to open the airways can help in alleviating
wheezing. They can be delivered using an inhaler or
nebulizer.
Ventilation is useful for patients with respiratory failure or
hypoventilation (excessively slow breathing). Ventilation is
the use of a machine (a ventilator) that helps the individual
to breathe normally. There are non-invasive as well as invasive
ventilation options available. Non-invasive ventilation is
either through the nose, mouth, or full-face masks. Invasive
ventilation involves inserting a tube into the windpipe, either
through the patient’s mouth or nose, or through an incision
in the neck.
In some cases, surgery to correct scoliosis may be required to
relieve the pressure on respiratory muscles and ease breathing.
Article available at: https://musculardystrop
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