Ideally, referral to a specialist respiratory physician should take place early in the disease course and regular assessment initiated. Dyspnoea is one of the most frightening symptoms of MND and there are a number of strategies that help to address this symptom and sensations of breathlessness.
MND Australia 2011
Additional management strategies for dysponea
When more severe shortness of breath appears the following measures are indicated:
- consult with a palliative care physician
- relieve anxiety - reassurance, meditation and/or medication
- correct posture in chair and bed
- recliner chairs and beds with adjustable back and leg supports may be helpful
- a semi-recumbent position may be most comfortable - this position allows the intercostal muscles and the diaphragm to work to greatest advantage
- consult pysiotherapist and occupational therapist
- improve secretion control
- retained secretions in the mouth and pharynx accompanied with weakened cough further compromise the airway and add to the person's discomfort and panic
- the physiotherapist may also be able to reduce anxiety by teaching controlled breathing exercises and assisted coughing techniques
Non-invasive positive pressure ventilation should be considered to treat respiratory insufficiency both to lengthen survival and to slow the rate of forced vital capacity decline (Miller and others 2009a).
Expiratory respiratory muscle weakness can lead to ineffective cough, retained upper airway secretions, and pulmonary infection (Miller and others 2009a)
Medications to manage shortness of breath and anxiety include opiates and benzodiazepines.
There are indications that early non-invasive positive pressure ventilation increases survival compared to late NIPPV (Chio and others 2009). Non-invasive ventilation (NIV) provides relief from symptoms such as fatigue, breathlessness and disturbed sleep patterns, but does not prevent progressive weakening of the respiratory muscles (Andersen and others 2007).
