Respiratory dysfunction in people with advanced multiple sclerosis

Respiratory dysfunction may occur in multiple sclerosis, and respiratory complications are the most common cause of death. There is limited evidence to guide assessment and management of respiratory dysfunction in people with advanced multiple sclerosis.

The aim of this study was to evaluate the assessment and management of respiratory dysfunction in people with advanced multiple sclerosis as part of their routine out-patient care.

The medical records of 105 people with multiple sclerosis with Expanded Disability Status Scale (EDSS) score ≥ 8.0 assessed in a multidisciplinary clinic from April 2021 to January 2024 were retrospectively reviewed. Clinical details including age, sex, EDSS score, dysphagia status, respiratory symptoms and planned respiratory interventions were recorded.

Sixty-four people (61%) reported at least one symptom suggestive of respiratory dysfunction including hypophonia, weak cough, difficulty in breathing, difficulty clearing airway secretions, chest infection and sleep apnoea. Forty-seven people (44.8%) received or were referred for respiratory interventions. Respiratory symptoms and interventions increased with advancing disability, respectively reported in 94% and 76% of those with EDSS ≥9.0.

Respiratory dysfunction is very common in people with advanced multiple sclerosis and increases with higher EDSS. Screening for respiratory dysfunction can be easily incorporated into routine clinical care by asking about respiratory symptoms. Referral for further assessment and intervention may be required, but this may be constrained by a lack of respiratory services for people with multiple sclerosis.