Breathing Problems

Reviewed by: HU Medical Review Board | Last reviewed: March 2022.

Multiple sclerosis (MS) has the ability to cause wide-reaching symptoms, including breathing problems. Breathing issues are rare compared to many other MS symptoms. However, they can be severe if they occur.1,2

Understanding breathing problems

Our breathing is controlled by the autonomic nervous system (ANS). The ANS controls functions we do not actively think about, like our heart beating and breathing. MS does not tend to affect the ANS. However, it can lead to muscle weakness or other symptoms that can cause breathing issues. Some of these include:1-4

  • Trouble taking a deep breath
  • Problems clearing the throat or coughing
  • Issues with swallowing
  • Difficulties with speech

Some breathing, swallowing, or speech problems occur late in a person’s MS journey. However, it is possible for these to be present early on. Each person’s experience will be different.1,2

Some breathing issues can be life-threatening and need immediate medical care. Others might be longer-term or mild. In either case, breathing issues can be scary and impact the ability to carry out daily tasks.

Why do breathing problems happen in MS?

In MS, the body mistakenly attacks its own healthy nerves. If the nerves that control the chest or abdominal muscles are impacted, breathing can be affected. Nerve signals are important in creating strong muscle contractions for deep breaths. If the chest muscles are too weak, breathing can become a challenge. This issue is even more of an obstacle for people with MS who are already fatigued. Working extra hard to take a full breath can be exhausting.1

MS can also make physical activity challenging. Over time, endurance is lost, and breathing can become difficult during even minor activities. Changes in posture as a result of not being active or MS-related damage can also make breathing hard. In addition, some drugs used to treat MS symptoms, such as pain, slow down breathing. This can cause issues, especially in people who already have a hard time breathing.1-3

It is also possible for MS to impact the area of the brain that controls speech, swallowing, breathing, and coughing. However, this is rare and usually only occurs in advanced MS.2,4

If a person has issues swallowing or coughing, it is more likely they will choke on food or aspirate. Aspiration occurs when food or other particles enter the lungs by accident. After aspiration, an infection in the lungs can develop. This is called aspiration pneumonia and can further impact breathing.1,4

This or That

Did you know that MS could cause breathing difficulty?

How are breathing problems diagnosed and treated?

Breathing problems can be a sign of a serious issue. If you have a sudden onset of trouble breathing or feel like you cannot catch your breath, seek urgent medical attention at the nearest emergency room right away.

For those with longer-term or non-emergent breathing issues, doctors may recommend several tests to figure out what is going on. Imaging like chest X-rays may be used to look for pneumonia or other lung disease. Pulmonary function tests (PFTs) to measure lung function and sleep studies can be helpful, too. These diagnose other underlying breathing issues, like sleep apnea.1,4

Breathing exercises may be helpful for those with weakened muscles. These can be taught by a specialist like a respiratory therapist and practiced daily at home to build strength. Speech/language pathologists can also help with exercises to improve swallowing or talking. It may be necessary to change what foods are eaten or the posture a person has when eating if these issues are severe.1

Aspiration pneumonia is treated with drugs. However, if choking continues to occur, a feeding tube may be needed to prevent future aspiration issues.1,4

Vaccination against certain types of pneumonia-causing bacteria is recommended for people at high risk.1,4

In certain cases, respiratory support, such as non-invasive ventilation, may be needed. Some drugs, like muscle relaxants and opioids for pain, may need to be avoided since these can have breathing-related side effects.1,4

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