About breathing

Lately I have noticed a change – among others – in myself. In the evening, when I lie on the couch, I have unusual breathing. I have to take deep breaths more often, it’s like I’m bubbling. As if I needed more air. I have been observing it for a few days, it does not happen every day. However, so far only when I am lying down. Sometimes there are also strange palpitations, I never thought that one could be related to the other. But it probably is. Always in the evening and always lying down. This led me to read up on what breathing is all about. So I came across an article by Abraham Lieberman, which I would like to share with you.

The info and findings below are based on research in Idiopathic Parkinson’s and other neurological diseases, but it can easily be compared to MSA.

Breathing is a basic life function that occurs automatically – usually without conscious experience. Breathing is controlled by the respiratory center in the brainstem, located below the basal ganglia and above the spinal cord. When the respiratory center sends a signal, the chest wall muscles and diaphragm, the muscles surrounding the lungs, contract. This increases the space between the chest wall and the lungs, decreasing the pressure inside the lungs (compared to the outside pressure), and the lungs inhale to equalize the inside pressure with the outside pressure. As the lungs expand to fill the space in the chest wall, a second signal is sent to relax the muscles. As the muscles relax, the space around the lungs narrows, the pressure in the lungs increases, the lungs exhale, and the air is pushed outward. The brainstem makes its decisions about the rate and depth of breathing based on information it receives from the body. This information includes the oxygen content of the air, the oxygen content of the blood, the content of exhaled gases, the carbon dioxide content of the blood, and the acidity or alkalinity of the blood. Carbon dioxide content is the most important factor in controlling respiratory rate and depth. 

Shortness of breath in heart disease

Shortness of breath, difficulty breathing, a conscious awareness of breathing, may occur due to disease of one or more heart valves. When the valves are scarred or leaky, fluid accumulates in the lungs and is not pumped into the circulation: This is called edema. Shortness of breath can occur because of heart muscle weakness. This is called cardiomyopathy. The heart is a muscle, a pump, that circulates fluid through the body. When the heart muscle is damaged by repeated heart attacks, inflammation, or drugs such as alcohol, the pump fails and fluid (edema) accumulates in the lungs.

Shortness of breath can occur because of a buildup of fluid in the pericardium, which surrounds the heart. This is called pericarditis. This fluid restricts the expansion and contraction of the heart, leading to heart failure – with fluid backing up into the lungs. Shortness of breath may occur due to a disturbed heart rhythm. This is called an arrhythmia. In an arrhythmia, the heart beats so fast that it does not have time to fill properly. This insufficient filling results in decreased contractile force, and fluid accumulates in the lungs.

Shortness of breath in lung disease

Shortness of breath occurs when airflow through the nose, trachea or bronchi is obstructed. The disorder may be caused by inflammation, infection, or obstruction of the nose or airways. Common causes include inflammation, infection, or allergies that lead to a “stuffy nose,” bronchitis, pneumonia, or asthma.

Shortness of breath occurs because the exchange of oxygen from the air into the lungs is disrupted. This exchange takes place in millions of tiny bubbles called alveoli, which surround the ends of the smallest bronchial tubes like tiny balloons. Impaired airflow into the lungs, or oxygen exchange, forces the patient to strain harder to breathe, decreasing the amount of oxygen taken in with each breath.

Shortness of breath also occurs with diseases that restrict the movement of the lungs, such as diseases that cause scarring (fibrosis) of the bronchi and alveoli. These include:

(1) Repeated infections with bacteria, fungi, and tuberculosis.
(2) Repeated irritation and inflammation from chemicals such as asbestos, coal dust, smoke, and certain medications.
(3) Collagen diseases (or diseases of the supporting tissues) such as lupus.

Risk factors for lung disease include:
(1) Cigarette smoking (a major risk). This includes smoking marijuana.
(2) Occupations in which chemicals or dusts are chronically inhaled, such as asbestos workers, miners, or firefighters.
(3) Chronic infections such as tuberculosis.

Shortness of breath may occur after light exertion or exercise, exertion or exercise that has not previously caused shortness of breath. Or, shortness of breath may occur after lying down. The circumstances under which the shortness of breath occurs may indicate whether the shortness of breath is due to heart or lung disease. For example, shortness of breath after lying down is more likely to indicate fluid congestion from a failing heart than from a failing lung. Shortness of breath due to lung failure, emphysema, on the other hand, is more likely to occur with exertion or exercise. Coughing and wheezing may accompany shortness of breath in both lung and heart disease.

Shortness of breath in diseases of the nervous system.

Shortness of breath occurs in diseases that weaken the muscles of the chest wall and diaphragm. These are the muscles that surround the lungs and act like bellows. When you breathe in, they contract, causing the pressure around the lungs to drop and the lungs to expand, forcing air from the atmosphere into the alveoli. On exhalation, the chest wall muscles relax, narrowing the space around the lungs and expelling the air. Diseases that cause weakness of the chest wall and diaphragm muscles include muscular dystrophy and myasthenia gravis. The resulting paralysis is similar to the intentional paralysis caused by curare-like agents used in anesthesia.

Shortness of breath occurs in diseases that inflame the nerves that control muscles. These conditions are called neuropathies and include Guillain-Barre syndrome.

Shortness of breath occurs in diseases of the spinal cord. The spinal cord controls muscles, including respiratory muscles. Spinal cord diseases include Lou Gehrig’s disease and polio. Shortness of breath occurs with strokes or spinal cord injuries, such as the injury that paralyzed Christopher Reeves (“Superman”), requiring him to breathe with a ventilator.

Shortness of breath in Parkinson’s can occur in several ways:

(1) The chest wall muscles and diaphragm can become stiff. During inhalation, they do not fully expand. And during exhalation, they do not relax completely. This impairs the bellows function of the lungs. 

At rest, the normal respiratory rate is 12 to 18 breaths per minute. In some patients with advanced PD, the respiratory rate exceeds 18 breaths per minute. Patients use more energy breathing, tire more easily and become short of breath. If they also have heart or lung disease or have smoked in the past, shortness of breath is exacerbated by these circumstances.

(2) Severe spinal deformity can restrict lung movement and cause shortness of breath. While some Parkinson’s patients have mild deformity, deformity severe enough to cause shortness of breath is rare. These patients are more comfortable sitting or standing than lying down.

(3) Dyskinesias or involuntary movements may occur. Some patients who fluctuate, who do not take levodopa constantly, may complain of shortness of breath. The shortness of breath may occur when they are “off,” that is, before taking levodopa or without, when the chest wall muscles and diaphragm are stiff. However, shortness of breath can also occur while taking levodopa if the dyskinesia causes the chest wall muscles and diaphragm to contract less efficiently.

Parkinson’s patients with rigid chest walls or severe spinal deformities may complain of shortness of breath during exertion or exercise. Or they may complain of shortness of breath when lying down. When we sit or stand, gravity normally assists the downward movement of the diaphragm. When we lie down, we lose the help of gravity. Some Parkinson’s patients are unable to compensate for this loss and complain of shortness of breath. In some patients, the shortness of breath is so troublesome that they are asked to sleep sitting up in a chair.

(4) Anxiety. Parkinson’s disease patients can be anxious like any other person, and this can lead to shortness of breath. 

Treatment of shortness of breath in Parkinson’s disease.

If a Parkinson’s patient complains of shortness of breath, either on exertion or while lying down, this needs to be investigated. The correct diagnosis can be made by an internist, a cardiologist, and a pulmonary specialist. If the shortness of breath

is not related to heart or lung disease, or if their contribution to the shortness of breath is small, then it is likely that the shortness of breath is related to Parkinson’s disease.

If the shortness of breath is related to stiffness of the chest wall muscles and diaphragm, additional anti-Parkinson’s medications, especially a long-acting dopamine agonist, may help. If the shortness of breath is related to dyskinesia, levodopa should be reduced. A long-acting agonist can be used to compensate for the reduced levodopa.

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