Pulmonary Involvement in Patients with Guillain–Barré Syndrome in Subacute Phase

Abstract

Objectives:To evaluate the pulmonary function in Guillain–Barre syndrome (GBS) patients in subacute phase and find clinical correlates of pulmonary dysfunction.Methods:This was a single-center, prospective, cross-sectional, hospital-based study in GBS patients performed in Department of Neurological Rehabilitation at a tertiary care institute. Clinical examination for pulmonary function was done by measuring chest expansion. The pulmonary function tests were carried out by Spirometry kit Microquark Cosmed, Italy. Fatigue was assessed by Fatigue Severity Scale, disability status by Hughes Disability Scale (HDS), and muscle weakness by Medical Research Council sum scores.Statistical Analysis:Statistical analysis was performed by Stata 11. The significance of P value was adjudged against an alpha of 0.05.Results:Twenty-eight patients were included with 17 (61%) men and mean age of 31 years. Median duration of symptoms was 16.5 days. There were 10 (36%) demyelinating and 18 (64%) axonal variants. Twenty-six (93%) patients scored more than 2 on HDS. All study participants reported fatigue. Twenty-two (78.6%) patients had chest expansion of <2.5 cm. Spirometry showed restrictive pulmonary dysfunction in 23 (79%) patients. Significant correlation was found between abnormal pulmonary function test and chest expansion (P = 0.003).Conclusion:Pulmonary dysfunction in GBS is common even during subacute phase. It needs to be identified and managed appropriately for better clinical outcome.

Sleep Disturbances Associated with Neurological Autoimmunity

“…In Guillain-Barré syndrome (GBS), an acute inflammatory polyradiculoneuropathy, presenting sensorimotor symptoms predominate and can be severe, causing respiratory weakness that may progress rapidly to become life threatening. Restrictive lung disease is found in 79% of GBS patients in the subacute phase [139], and 20-30% of GBS patients require mechanical ventilation [140].…”

Psychiatric Sequelae of Guillain-Barré Syndrome: Towards a Multidisciplinary Team Approach

“…Conflicting reports have suggested that not all GBS patients have favourable responses to exercise [45,46]. A lack of improvement in residual fatigue may not be easy to rationalise, due to the absence of an underlying pathophysiological mechanism (such as nerve dysfunction, anaemia, hypothyroidism, diabetes, or chronic illness) [7,30]. However, it is important to consider whether persistent fatigue may be due to a psychiatric mechanism (e.g., depression) that hampers recovery independent of exercise-induced improvements in muscle strength [28].…”

“…The natural history of the disease involves an acute phase characterised by physical disability which reaches a plateau within two weeks. Timely clinical management is required due to the risk for respiratory failure resulting from dysfunction of the phrenic nerve, with 20%-30% of patients requiring assisted ventilation [1,6,7]. Early signs of respiratory failure include tachypnoea, tachycardia and air hunger, while late signs include use of accessory respiratory muscles, paradoxical breathing and orthopnoea due to diaphragmatic paresis [7].…”

“…Timely clinical management is required due to the risk for respiratory failure resulting from dysfunction of the phrenic nerve, with 20%-30% of patients requiring assisted ventilation [1,6,7]. Early signs of respiratory failure include tachypnoea, tachycardia and air hunger, while late signs include use of accessory respiratory muscles, paradoxical breathing and orthopnoea due to diaphragmatic paresis [7]. After the acute phase, patients enter a rehabilitation phase with most returning to usual daily activities within three years, with greater improvements amongst younger patients.…”

Respiratory Involvement in Guillain–Barre Syndrome: The Uncharted Road to Recovery

“…The study published in the current issue titled, “Pulmonary involvement in patients with Guillain- Barré syndrome in sub-acute phase”[ 9 ] highlights the impairment in lung function after acute illness and attempts correlation with clinical parameters at presentation and outcome measures in subacute phase. Chest expansion has been found to be an easily measurable variable which is statistically related to pulmonary dysfunction.…”