Breathing can be affected in muscle conditions because two muscles may be impacted by the neuromuscular disorder. These include the diaphragm and the muscles between the ribs – the intercostals. These breathing muscles can become weaker over time and lead to a poor lung volume and a weaker cough. We need a cough to clear secretions from the lungs. It is also true that breathing is impacted by spinal posture and scoliosis.
Respiratory issues in muscle conditions vary greatly between individuals and each condition and it is therefore important that individuals receive an assessment and care plan from professionals trained in respiratory care in NMD.
This care plan can include advice on keeping lungs healthy, as well as how to manage their breathing if they get a cold or an infection. Keeping healthy includes keeping up to date with immunizations, having a healthy varied and balanced diet, keeping active, sleeping well, and ensuring good hand hygiene to prevent the transmission of coughs and colds.
Respiratory assessment often takes place in specialist neuromuscular centres and involves simple tests such as forced vital capacity (FVC) and perhaps a peak cough flow (PCF) to measure cough strength. If, for any reason these are reduced, then a further referral may be made to a respiratory or home ventilation clinic for further assessment and management.
There are several ways in which we can assist in promoting good breathing and coughing using things such as incentive spirometry, using a lung volume recruitment bag and breath stacking to facilitate a good cough. Further referral to home ventilation teams can provide assisted cough machines as well as non-invasive ventilatory support.