Pulmonary Function and Dysfunction in Multiple Sclerosis

Are the neurophysiological techniques useful for the diagnosis of diaphragmatic impairment in multiple sclerosis (MS)?

“…These findings support the evidence that in normal subjects the CMCT of different muscles is compatible with the craniocaudal distribution of the motor nuclei and therefore with the conduction distance along the corticospinal pathway. Our observations are also in agreement with previous studies (Buyse et al, 1997;Smeltzer et al, 1988) on the respiratory involvement in MS, which found that the involvement of expiratory muscles appeared to be more pronounced than that of the inspiratory muscles. The authors explained that paralysis in advanced MS tended to ascend slowly from lower extremities to upper extremities, as a result, the first respiratory muscles to be affected should be the abdominal muscles followed by the intercostal muscles.…”

“…We found a correlation between neurological disability and pulmonary dysfunction, in fact in the neurologically more disabled group, significantly worse pulmonary function tests (FVC % pred, FEV1 % pred, PEF % pred) were measured, as described by others (Smeltzer et al, 1988). This is probably due to the difficulty of some of these patients with a more severe motor impairment, to control the inspiratory and expiratory muscles when utilized during maximal effort.…”

“…In paraparetic MS patients, expiratory muscle weakness increases as the upper extremities become involved; the presence of concomitant bulbar dysfunction enhances the likelihood of aspiration pneumonia (Smeltzer et al, 1988). However, the incidence of respiratory muscle involvement in MS is probably underestimated because patients with restricted motor activity usually do not complain of dyspnea.…”

Expiratory Muscle Strength Training in Persons With Multiple Sclerosis Having Mild to Moderate Disability: Effect on Maximal Expiratory Pressure, Pulmonary Function, and Maximal Voluntary Cough

“…5,[15][16][17]21 Although we found greater MEP improvements in subjects with MS than has previously been reported, these subjects were still significantly lower than the healthy controls. 3,5,7,8 The basis for the diminished strength of the expiratory muscles in subjects with MS may result from de-conditioning.…”

“…3,5,7,8 In contrast, other patient populations have had improvement in pulmonary function following expiratory and/or inspiratory muscle strength training. [10][11][12] The effectiveness of cough, an important airway defense mechanism, 13 is dependent on the neural control influencing the strength and the velocity of airflow, so it is consistent that impaired cough has been reported in patients with MS. 3,[14][15][16][17] No objective data exist as to the effect of expiratory and/or inspiratory muscle strength training on maximal voluntary cough in patients with MS; limited data are available on the effects in healthy subjects. 13 The primary aim of this study was to examine if expiratory muscle strength training (EMST), designed as a shorter training duration, was effective for increasing maximal expiratory pressure (MEP), pulmonary function, and maximal voluntary cough in both healthy subjects and subjects with MS. A second aim was to determine if gains would be maintained during a detraining period.…”