Breathing Issues and Multiple Sclerosis

Respiration — or breathing — is primarily under the control of the autonomic or “automatic” nervous system. This is the part of the central nervous system that controls vital functions such as heartbeat and respiration without conscious thought. It is unusual for multiple sclerosis to affect the autonomic nervous system. For this reason, it’s uncommon for breathing problems to occur in MS as a direct result of loss of autonomic control.

In MS, the most common cause of respiratory problems is loss of muscle strength and endurance. Just as a person can experience muscle weakness in the arms or legs, weakness can occur in the muscles of the chest and abdomen that are involved in breathing. And like weakness in other parts of the body, weakness of the muscles related to proper breathing and lung function can begin to occur early in the disease course and gradually worsen over time. People with weakened breathing muscles have to work harder to inhale and exhale. This extra effort can be quite tiring, particularly for people who already experience a significant amount of MS fatigue.

Respiratory problems can also interfere with speech. It can be much more difficult and tiring for people to carry on a conversation or speak loudly enough to be heard. A speech/language pathologist can recommend exercises and tools to enhance speech and communication. Learn more about MS-related speech symptoms.

Does MS cause shortness of breath?

No. Shortness of breath is not usually a direct symptom of MS. If you are experiencing shortness of breath, go to the emergency room.

Some medications, such as anti-anxiety medication (benzodiazepines such as Xanax and Ativan), muscle relaxants and opioid analgesics, can depress breathing. The use of these medications should be carefully monitored in anyone with a history of respiratory distress or swallowing problems. Typically, these medications should not be used in combination with one another as this greatly increases the risk of respiratory depression potentially leading to serious harm and even death.

Breathing problems can also occur as a result of aspiration pneumonia. This results from the inability to clear secretions from the nose and throat or from swallowing difficulties that result in inhalation of food particles into the lungs. If you begin to experience swallowing problems and/or choking while eating or drinking, get evaluated by a speech/language pathologist. In addition to exercises and other forms of therapy to improve your ability to swallow, the therapist may also recommend dietary changes and postural changes while eating to minimize these issues. Sometimes a feeding tube is necessary to avoid continued risk of aspiration pneumonia.

Evaluations of breathing problems are most often done by a healthcare provider with special training in this area. If your respiratory function becomes affected, a therapy program including breathing exercises may be recommended to strengthen the muscles that support your lungs and breathing.

Everyone living with MS can benefit from adding breathing exercises into their regular wellness routine. Once you have consulted with your healthcare provider on what exercise program might be best for you, consider viewing our Breathing Tips for MS video for guided breathing exercises.

Breathing assistance devices

Some studies have determined that respiratory muscle training may help strengthen breathing muscles, improve respiratory function, clear airways, decrease fatigue and increase quality of life. This muscle training may include use of a device, such as a positive expiratory pressure (PEP) device or an acapella device (sometimes called a green pickle), to assist you in clearing your lungs and keeping airways open. Discuss the use of a device with your doctor and your rehabilitation care team.