Breathing Problems in Parkinson’s Disease

 Dr. Chris Living with Parkinson's, Signs & Symptoms

The troublesome neurodegenerative disorder Parkinson’s disease manifested by the symptoms of tremors, slowing of movements, rigidity and many more associated motor complications, caused by the loss of dopaminergic neurons in the nigrostriatal region of the brain is one of the most common cause of disability amongst the elderly population. 

Parkinson’s breathing is a complicated issue. Normal aging should not cause breathing difficulty and people with Parkinson’s disease, although mostly elderly, should not have breathing problems unless there is some underlying cause. Getting out of breath on undertaking unaccustomed exercise is not really a cause for concern. Some people with Parkinson’s disease experience shortness of breath and undergo testing, but are found to have a healthy lung function. 

It is quite possible, however, for a person with Parkinson’s disease to also suffer from some pre-existing lung or heart condition which may cause some amount of breathing difficulty. If shortness of breath, wheezing, cough or chest discomfort does develop, even without a known medical problem, careful assessment and treatment is definitely indicated. Shallow breathing starves the vital cells of body off oxygen, which exacerbates a myriad of unfavorable things including fatigue and constipation.

Causes of Breathing Difficulty in Parkinson’s Disease

Dyspnea, breathing difficulty, or shortness of breath – whatever you may choose to call it – can be very distressing, and even frightening, for the person who suffers with it, especially if there have been severe episodes. The causes could be any of the following :

• Aspiration Pneumonia: It develops when the food particles lodges down the wrong pipe and settle in the lungs to cause infection. The Parkinson’s patient usually aspirates in the advanced stages due to marked motor impairment and muscle dystonia, which leads to swallowing difficulties and specific changes in the swallowing pattern. In fact, it is a well established fact that, aspiration pneumonia is the leading cause of death among the patients in Parkinson’s disease.

• Although there has been limited research conducted on this topic, but some of these studies have found that the patients of Parkinson’s disease usually inhale a lower volume of air with each passing breath, as compared to the healthy people, which might aid to breathlessness.

• It might also be possible that the rigidity of the muscles in the chest and abdomen, which is a symptom of motor impairment associated with Parkinson’s disease might lead to breathlessness.

• Wearing off episodes: These episodes are usually experienced among people who have been taking the levodopa for several years as the medication for Parkinson’s disease The wearing off episodes manifest when the medication’s benefit wears off and the shortness of breath occurs before it’s time for the next dose.

• Chronic lung diseases such as COPD (chronic obstructive pulmonary disease), chronic asthma, emphysema and chronic bronchitis or an acute exacerbation, can cause shortness of breath accompanied by wheezing, cough or chest discomfort.

• Pneumonia: chest infections are more common in people with Parkinson’s disease, than in the general population.

• Pulmonary embolism. 

• Pulmonary hypertension.

• Heart failure and other heart conditions such as myocardial infarction (heart attack).

• Stroke. The symptoms of a stroke may sometimes be missed in the late stages of Parkinson’s disease as caregivers may mistaken the presentation for the progression of Parkinson’s disease.

• Choking on an object.

• Severe anemia.

• Allergic reactions. This should be monitored carefully to assess if the reaction is caused by any medication.

• Common cold, sinusitis or other nasal problems.

• High fever.

• Associated diseases such as lung cancer or tuberculosis.

• Anxiety or panic attacks. Parkinson’s disease patients often suffer from depression, anxiety disorders, dementia and other emotional problems. This could sometimes be the cause of hyperventilation and breathing problems. When all other causes have been excluded, this diagnosis should be kept in mind.

Shortness of breath could be due to any of the above causes or it may be a symptom of end stages of Parkinson’s disease.

Risk Factors

The associated risk factors may include :

1. Air pollution.
2. Smoking.
3. High altitude.
4. Obesity.

Diagnosis

It is important to diagnose the cause of the breathing difficulty. If the patient has a known medical condition other than Parkinson’s disease, diagnosis becomes easy. Even so, a thorough physical examination will need to be conducted along with other tests if indicated. This may include :

• Blood tests, including arterial blood gases, especially oxygen saturation.
• Chest x-ray.
• ECG.
• Echocardiogram.
• Pulmonary function tests.
• Spirometry.
• Methacholine challenge test.
• Allergy tests.
• CT scan.

Prevention and Treatment

There is no specific therapy to treat shortness of breath amongst patients of Parkinson’s disease. Various tips can come handy to cope with the breathing difficulties, provided the root cause is pre-determined.

• Proper identification and treatment of the non-parkinson’s cause of dyspnea, such as a lung or a heart disease is usually the mainstay of treatment.

• Simple breathing exercises: Breathe in and breathe out with a calm mind and practice simple meditation exercises. This method brings in an ample amount of oxygen possible. Also, the simple deep breathing exercises aligns the diaphragm to press down on the intestine, so as to relieve the Parkinson’s associated constipation, and the lungs function at a higher level to cleanse the toxins. Not only the breathing exercises brings in oxygen, but it also keeps the patient at calmer nerves and wards off anxiety, which in itself is an independant grave culprit for shortness of breath.

• Regular exercise as appropriate, keeping in mind the condition of the patient suffering from Parkinson’s disease. Staying active improves the pulmonary function and increases the ability to take deep breaths. A structured exercise regime improvises the cardiorespiratory system.

• Appropriate psychotherapy for the patients with anxiety including the medications, exercise and lifestyle changes is also a crucial determinant in the relief of Parkinson’s associated dyspnea.

• Consult a speech-language pathologist, who can address the issues related to swallowing.

• Giving up smoking is very important.

• Immunization. Bed-ridden, depressed and immobile Parkinson’s disease patients are very susceptible to contracting infections because of their low immunity status. Appropriate vaccinations should be administered to prevent infections such as the flu and pneumonia.

• A nutritious diet, including fruits and vegetables, help to build up the immune system. Vitamin and zinc supplements may also help. Avoid close contact with others who have a cold, flu or other infectious diseases.

• Medication to relieve breathing difficulty should only be used if your doctor prescribes it in order to reduce the chances of drug interactions with Parkinson’s disease medicines.

• Oxygen administration can help when breathing difficulty becomes severe. Hospitalization may become necessary at this stage.

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