Breathing & Respiratory Difficulties
Some people with Parkinsons disease may experience shortness of breath. There is no clear cause underlying respiratory dysfunction in PD, its frequency or the effect that medications have on respiration. Several reasons for shortness of breath in PD include:
- Wearing off is a common experience among people with PD who have been taking levodopa for several years. These occur when the medication benefit wears off and PD symptoms return before the next dose.
- Respiratory dyskinesia refers to an occurrence of irregular and rapid breathing when levodopa medications reach their peak effect. These may accompanied by involuntary body movements, typically experienced as dyskinesia.
- Anxiety is a common symptom of PD that may also exacerbate shortness of breath, whether by itself or as a consequence of wearing off of the medication.
- Aspirationpneumonia is a pneumonia that develops after food or liquid goes down the wrong pipe. Advanced PD can increase the risk of swallowing difficulties, choking and aspiration pneumonia.
- Non-PD health issues include conditions such as asthma, allergies, lung disease, heart disease and other conditions that may cause shortness of breath.
What Is Parkinsons Disease
Parkinsons disease is a chronic, neurodegenerative disorder that is generally characterized by motor changes such as tremors, slowness of movement , rigidity, and difficulty controlling movement.
People with PD may experience motor, non-motor, and cognitive changes during the course of their disease. Parkinsons has no known definitive cause or cure. Its onset occurs most commonly after age 60.
Dyspnea and respiratory distress are among the noted non-motor symptoms first described in 1817 by James Parkinson in his “Essay on the Shaking Palsy”. As it is often stated, Parkinsons affects each person differently.
Breathing Problems And Parkinsons Disease
Usually, trouble breathing is not thought of as a symptom of PD. Those with PD who complain of this will typically have testing of their heart and lung function. This is necessary since, as we continue to emphasize, a person with PD can develop medical problems unrelated to PD and needs every new symptom evaluated like someone without PD. However, often the testing does not reveal a cardiac or pulmonary abnormality. Could difficulty breathing be a symptom of PD itself?
There are a number of ways in which difficulty breathing may be a symptom of PD:
Shortness of breath can be a wearing-OFF phenomenon
Some non-motor symptoms can fluctuate with brain dopamine levels, which means that they change as a function of time from the last levodopa dose. For some people, shortness of breath can be one of the non-motor symptoms that appears when medication levels are low. However, shortness of breath can be due to anxiety which can also be a wearing-OFF phenomenon. Sometimes it is not possible to determine whether the key symptom is anxiety or shortness of breath. Treatment involves changing medication dosing and timing so that OFF time is minimized. You can view this webinar which discusses the concept of wearing OFF and potential treatments.
Abnormal breathing can be a type of dyskinesia
Restrictive lung disease
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What Are The Causes
People with Parkinsons may experience varied respiratory symptoms, ranging from shortness of breath without exertion to acute stridor, the sudden onset of high-pitched breathing sounds when taking a breath.1,3
Dysfunction can be caused by a variety of factors including physiological restrictive changes in the lungs, upper airway obstruction, and response to medications.1,3
Tips For Coping With Breathing Difficulties
- Work with your doctor to identify and treat any non-PD causes of shortness of breath, such as lung disease, heart disease or lack of physical conditioning and endurance.
- Exercise as much as possible. Shortness of breath may lead a person to move less. Less physical activity reduces the ability to take deep breaths. Staying active improves pulmonary function.
- Take steps to cope with anxiety. Talk with your doctor to figure out what sets off anxiety and find treatments and techniques that work for you.
- If you have experienced aspiration pneumonia, speak to your doctor about being evaluated by a speech-language pathologist who can help you address issues related to swallowing.
- Give up smoking.
Page reviewed by Dr. Addie Patterson, Movement Disorders Neurologist at the Norman Fixel Institute for Neurological Diseases at the University of Florida, a Parkinsons Foundation Center of Excellence.
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Origins Of Breathing Disorders
The book by Leon Chaitow and co-authors cited above explains how breathing disorders are intrinsically linked to chronic stress and anxiety. The shallow, fast chest breathing through the mouth is a hallmark of the body preparing itself for the exertion of flight or fight due to a stress response. While this adaptive in acute stress situations, when stress is chronic and the body is spending a lot of time in fight or flight, the associated pattern of breathing becomes habitual, and eventually the system gets stuck in the new equilibrium of the CO2 intolerant state. However, the vicious circle work both ways, because overbreathing itself puts the body into a stress response state and feeds anxiety. A very good tutorial about the two way links between anxiety and breathing patterns is given by Robert Litman in the video below.
It is not surprising therefore that people with PD can present with disordered breathing associated with chronic stress and anxiety, since there are very significant overlaps between the other symptoms of chronic stress and those of Parkinsons Diseases, and ingrained fight or flight behaviours are common to the pre-diagnosis background histories of people with PD. Conversely, it is important to note that techniques which have been developed to treat breathing disorders should also help to decrease the symptoms of PD, including reduction of anxiety and increasing resilience to stress.
Dyspnea Is A Specific Symptom In Parkinsons Disease
Article type: Research Article
Authors: Baille, Guillaumea | Perez, Thierryb | Devos, Davidd | Machuron, Françoisc | Dujardin, Kathya | Chenivesse, Cécileb | Defebvre, Luca | Moreau, Carolinea *
Affiliations: Department of Neurology, Expert Center for Parkinsons Disease, INSERM UMRS_1171, Lille University Medical Center, LICEND COEN center, Lille, France | CHU Lille, Lung Function Department, Univ Lille, INSERM 1019, CNRS UMR 8204, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France | Univ. Lille, CHU Lille, EA 2694 – Santé Publique: Épidémiologie et Qualité des Soins, Department of Biostatistics, Lille, France | CHU Lille, Department of Allergy and Respiratory Medicine, Competence Center for rare lung diseases, Univ. Lille, CNRS, INSERM, Institut Pasteur de Lille, U1019 – UMR 8204 – CIIL – Center for Infection and Immunity of Lille, Lille, France | CHU Lille, Department of Medical Pharmacology, Lille University INSERM 1171, Lille, France
Correspondence: Correspondence to: Caroline Moreau, MD, PhD, Department of Neurology, Expert Center for Parkinsons Disease, INSERM UMRS_1171, Lille University Medical Center, LICEND COEN Center, Lille, France. Tel.: +33 320445962 E-mail: .
Keywords: Parkinsons disease, dyspnea, non-motor symptom, anxiety, ventilatory dysfunction
Journal: Journal of Parkinson’s Disease, vol. 9, no. 4, pp. 785-791, 2019
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What Causes Parkinsons Disease
The NHS explained: Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra.
This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body.
A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.
Exactly what causes the loss of nerve cells is unclear.
Most experts think that a combination of genetic and environmental factors is responsible.
Exercises For Restoring Health Breathing
There are various suggested types of exercise which can help gradually shift the equilibrium point of CO2 intolerance back to healthy states. However, all of these emphasize nose breathing over mouth breathing , and diaphragmatic breathing over chest breathing. This represents an immediate roadblock for people with PD, for whom mouth breathing is likely to have become so ingrained that it feels like the nose is permanently stuffed up, and who have diaphragms which are so frozen that it cannot voluntarily be flexed. However, it is possible to open the nose in the majority cases through some simple exercises. Robert Litman in the above video demonstrates this, and below is another video of Patrick McKeown on the topic. See also my article on how I restored nose breathing with the help of a red light anti-allergy device. It is also possible to restore access to diaphragmatic breathing, as I covered in another article, which explains how I used Block Therapy to achieve this.
Once nasal and diaphragmatic breathing is made possible there are a few different types of breathing exercises one try for restoring CO2 tolerance to more normal levels. It is important to note that these exercises are not necessarily targeted at immediate regulation of the Nervous System, unlike breathing methods designed for in-the-moment relaxation or mobilization, but are aimed at long term retraining of breathing patterns in order to restore healthy oxygenation levels to the brain and muscles.
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Parkinson’s Diseasesigns And Symptoms
Parkinson’s generally progresses slowly, sometimes taking years for symptoms to appear. The disease usually strikes adults over age 50, although it has been diagnosed as early as age 20. About 15 percent of Parkinson’s patients have a family history of the disease.
Because it develops gradually, most people have many years of productive living after being diagnosed.
Some of the first symptoms commonly experienced with Parkinson’s include the following:
- Rigidity Arms and legs become stiff and hard to move
- Tremors Rapid shaking of the hands, arms or legs
- Slowed movements Difficulty starting or completing movements, called bradykinesia
- Impaired balance Lack of balance or difficulty adjusting to sudden changes in position
These symptoms may make it difficult for you to walk, pick up and hold things, eat, write, or react quickly to prevent injury if you fall.
Other symptoms include difficulty speaking or swallowing, drooling, stooped posture, inability to make facial expressions, oily skin, cramped handwriting, shortness of breath, constipation, increased sweating, erectile dysfunction, difficulty sleeping, problems urinating and anxiety.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
Parkinsons Can Cause An Unusual Type Of Breathing Issue
- Dr. keith Roach
Dear Dr. Roach My husband has Parkinsons disease. He also has a stent in his heart. We have been to many doctors to address a breathing problem: fast breathing. He experiences this daily, and we are told that it is anxiety. It is difficult to watch him go through this. It sometimes happens before he is due for his Sinemet, but other times right after taking it.
He has been prescribed Xanax, clonidine, cannabidiol-infused gummies and a few others. One doctor says it is from Parkinsons, but the rest say it is anxiety. E.W.
Answer Shortness of breath can have many causes, but someone with Parkinsons disease has an unusual possibility, called respiratory dyskinesia. This is an involuntary rapid breathing that causes distress, and it usually happens an hour after taking a medication like Sinemet. Changing the dose can help with diagnosis, and working with a neurologist to adjust the dose of the Sinemet can solve the problem. I would start with an expert on Parkinsons. Keeping a diary of when he takes his medication and when the breathing trouble starts and stops will be helpful, as would a video of what it looks like when happening.
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Eating And Swallowing Problems And Parkinsons
Research suggests that eating and swallowing difficulties affect about a 90% of all people with Parkinsons. The true figure may be even higher as some people do not report the problem to their health care team.
Swallowing is a motor function that includes three stages.
- The first stage is the oral phase: food is chewed and mixed with saliva to form a soft ball called bolus. The tongue then pushes the bolus to the back of the mouth, triggering the swallow reflex.
- The second stage is the pharyngeal phase: it is the involuntary closure of the larynx by the epiglottis and vocal cords, which temporarily inhibites breathing. These actions prevent food from going down the wrong pipe into the trachea .
- The third stage is the esophageal phase: the bolus moves into the esophagus, the muscular tube that contracts to push the bolus into the stomach.
Unfortunately, many people with Parkinsons experience swallowing problems due to reduced control and muscle tone of the jaw, lips, tongue and throat muscles, especially in later stages of the condition. Eating and swallowing becomes slower and requires more effort.
People with Parkinsons are at particular risk of aspiration due to a delay in the triggering of their swallow reflex. This compromises the effectiveness of the airway protection while swallowing. This can lead to aspiration pneumonia due to a lack of coughing if food enters the windpipe, allowing food to reach the lungs unchecked.
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What Do The Lungs Do
When you breathe in, your lungs take in oxygen, which is then circulated around your body, providing you with energy.
Physical activity causes the lungs to increase their rate of breathing to match the action of the heart, which works harder to pump blood faster round the body, particularly to the muscles. The lungs and ribcage are flexible enough to expand like bellows. They adjust to the need for deeper, bigger breaths.
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Apnoea In Parkinson’s Disease
The presence of apnoea syndrome has been studied in PD as well. Apnoea syndrome is probably related to a central dysfunction of the brainstem respiratory centres and/or a peripheral airways involvement. However, different studies have produced conflicting results, probably according to the different samples of patients and methods used.
Apnoea occurring during sleep could be classified as central , obstructive and mixed nonetheless, these patterns have not been studied systematically in PD and a clear stratification is not available in the current literature. Most studies focused on obstructive apnoea rather than central.
Conflicting results have been reported about the prevalence of obstructive apnoea syndrome in PD patients Mariaet al. identified a higher prevalence of obstructive apnoea in PD populations, whereas others found less occurrence of obstructive apnoea compared to controls , or even no apnoea or sleep abnormalities . De Cocket al. tried to explain this phenomenon, postulating a possible protective contribution due to rapid eye movement sleep behaviour disorder , in which the physiological muscle atonia during REM sleep is absent and may prevent upper airway closure.
Indirect Consequences Of Stress And Anxiety
The way we breathe is a powerful aspect of self-expression. Anxiety, emotional constipation, and other habits of mind and dysfunctional and self-limiting behavioural patterns might be associated with strong breathing patterns, especially shallow breathing.
Shallow breath is what we do when we literally hide . It is also what we do when we feel like we want to hide! Deep breathing is one of the main practical suggestions for fighting anxiety. Its a feedback loop.
Habitually breathing shallowly can be so subtle for so long that we dont even realize theres a problem until all the contributing factors and bad habits and vicious cycles are too deeply entrenched to break free a classic boiling frog kind of problem.
All of this is a rather complicated mess to try to sort out, but Im not going to leave you hanging. Here are several relevant, practical self-help articles. They all focus on what you can do about these issues:
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Parkinsons Symptoms And The Lungs
Exercising your lungs, chest muscles and rib cage is important when you have Parkinsons.
- Your chest wall can become stiff, and the muscles weaker. This can make it harder to breathe or cough.
- Changes in posture can make you bend over or stoop forwards, which reduces the amount of air you can take into your lungs.
- Wearing off and involuntary movements can make your breathing more erratic and shallow.
It might sound scary, but pneumonia, a respiratory complication, is the main reason people with Parkinsons are admitted to hospital in an emergency and can be life-threatening.
In addition to this, stress, anxiety or other medical conditions can also affect how you breathe.
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Parasympathetic Nervous System And Your Heart
There are a number of special receptors for the PSNS in your heart called muscarinic receptors. These receptors inhibit sympathetic nervous system action. This means theyre responsible for helping you maintain your resting heart rate. For most people, the resting heart rate is between 60 and 100 beats per minute.
On the other hand, the sympathetic nervous system increases heart rate. A faster heart rate pumps more oxygen-rich blood to the brain and lungs. This can give you the energy to run from an attacker or heighten your senses in another scary situation.
According to an article in the journal Circulation from the American Heart Association, a persons resting heart rate can be one indicator of how well a persons PSNS, specifically the vagus nerve, is working. This is usually only the case when a person doesnt take medications that affect heart rate, like beta-blockers, or have medical conditions affecting the heart.
For example, heart failure reduces the response of the parasympathetic nervous system. The results can be an increased heart rate, which is the bodys way of trying to improve the amount of blood it pumps through the body.
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