A Narrative Review of Respiratory Impairment, Assessment, and Rehabilitation in Multiple Sclerosis

Abstract

<b><i>Background:</i></b> Respiratory impairment is a problem seen in people with multiple sclerosis (pwMS) from the early stages of the disease but not frequently recognized by clinicians until the later stages. It is seen in different ways, such as respiratory muscle weakness, change in pulmonary volumes, and decrease in cough efficiency. This situation has consequences affecting individuals’ physical fitness, participation in daily life, and quality of life. <b><i>Summary:</i></b> This review explains possible respiratory impairment mechanisms, related problems, assessment, and rehabilitation approaches in pwMS. <b><i>Key Messages:</i></b> It is recommended a comprehensive assessment of respiratory functions in pwMS regardless of the disease severity and stage. In addition, pulmonary rehabilitation and other exercises can have positive effects on the respiratory functions of pwMS. In future studies, specific training parameters should be determined for pwMS to achieve optimal benefits. There is also a need for studies that apply respiratory muscle training in pwMS who have a high disease severity and limited participation in the activities of daily living.

Respiratory issues in patients with multiple sclerosis as a risk factor during SARS-CoV-2 infection: a potential role for exercise

“…Weakened respiratory muscles, especially expiratory ones, are a prevalent detriment in advanced phase of MS disease [ 167 , 173 , 174 ]. Paraplegic progression from distal to proximal in MS causes impairment in expiratory muscles prior to the diaphragm and intercostal muscles [ 175 ]. The regulation of respiratory muscle function is controlled in the regions of the brain stem and spinal cord, dorsal, and ventral respiratory centers.…”

“…Inspiratory muscle training has affirmative effects on cardiac function by involving in autonomic nervous system; for example, increasing parasympathetic activity [ 320 , 321 ]. Elevated exercise-mediated intrathoracic pressure triggers baroreflex activity leading to promoted venous return which in turn mitigates heart sympathetic activation during resting condition [ 175 ]. Despite potential influences on respiratory muscles, exercise training defies the cardiac problems incurred in MS and COVID-19 diseases and therefore prevents exacerbating ventilation process.…”