Normal aging should not cause breathing difficulty and people with Parkinson’s disease, although mostly elderly, should not have breathing problems unless there is some underlying cause. Getting out of breath on undertaking unaccustomed exercise is not really a cause for concern.

It is quite possible, however, for a person with Parkinson’s disease to also suffer from some pre-existing lung or heart condition which may cause some amount of breathing difficulty. If shortness of breath, wheezing, cough or chest discomfort does develop, even without a known medical problem, careful assessment and treatment is definitely indicated.

Causes of Breathing Difficulty in Parkinson’s Disease

Dyspnea, breathing difficulty, or shortness of breath – whatever you may choose to call it – can be very distressing, and even frightening, for the person who suffers with it, especially if there have been severe episodes. The causes could be any of the following :

• Chronic lung diseases such as COPD (chronic obstructive pulmonary disease), chronic asthma, emphysema and chronic bronchitis or an acute exacerbation, can cause shortness of breath accompanied by wheezing, cough or chest discomfort.

• Pneumonia.

• Pulmonary embolism.

• Pulmonary hypertension.

• Heart failure and other heart conditions such as myocardial infarction (heart attack).

• Stroke. The symptoms of a stroke may sometimes be missed in the late stages of Parkinson’s disease as caregivers may mistaken the presentation for the progression of Parkinson’s disease.

• Choking on an object.

• Severe anemia.

• Allergic reactions. This should be monitored carefully to assess if the reaction is caused by any medication.

• Common cold, sinusitis or other nasal problems.

• High fever.

• Associated diseases such as lung cancer or tuberculosis.

• Anxiety or panic attacks. Parkinson’s disease patients often suffer from depression, anxiety disorders, dementia and other emotional problems. This could sometimes be the cause of hyperventilation and breathing problems. When all other causes have been excluded, this diagnosis should be kept in mind.

Shortness of breath could be due to any of the above causes or it may be a symptom of end stages of Parkinson’s disease.

Risk Factors

The associated risk factors may include :

1. Air pollution.
2. Smoking.
3. High altitude.
4. Obesity.

Diagnosis

It is important to diagnose the cause of the breathing difficulty. If the patient has a known medical condition other than Parkinson’s disease, diagnosis becomes easy. Even so, a thorough physical examination will need to be conducted along with other tests if indicated. This may include :

• Blood tests, including arterial blood gases, especially oxygen saturation.
• Chest x-ray.
• ECG.
• Echocardiogram.
• Pulmonary function tests.
• Spirometry.
• Methacholine challenge test.
• Allergy tests.
• CT scan.

Prevention and Treatment

• Regular exercise as appropriate, keeping in mind the condition of the patient suffering from Parkinson’s disease.

• Giving up smoking is very important.

• Immunization. Bed-ridden, depressed and immobile Parkinson’s disease patients are very susceptible to contracting infections because of their low immunity status. Appropriate vaccinations should be administered to prevent infections such as the flu and pneumonia.

• A nutritious diet, including fruits and vegetables, help to build up the immune system. Vitamin and zinc supplements may also help. Avoid close contact with others who have a cold, flu or other infectious diseases.

• Medication to relieve breathing difficulty should only be used if your doctor prescribes it in order to reduce the chances of drug interactions with Parkinson’s disease medicines.

• Oxygen administration can help when breathing difficulty becomes severe. Hospitalization may become necessary at this stage.