From the Guidelines
Parkinsonism has a significant impact on the respiratory system, primarily through the development of dysphagia, which affects more than 80% of patients with Parkinson's disease (PD) and is associated with a high risk of aspiration and pneumonia 1.
Key Effects on the Respiratory System
- Dysphagia, or swallowing difficulties, is a common complication in PD patients, with a prevalence of 35% based on subjective outcomes and increasing to 82% when objective measures of swallowing dysfunction are considered 1.
- The risk of silent aspiration is high in PD patients, which can lead to pneumonia, a major cause of death in these patients 1.
- Abnormal breathing patterns, including irregular breathing rhythms and decreased ventilatory responses to hypoxia and hypercapnia, can occur due to autonomic dysfunction and upper airway dysfunction 1.
- Postural abnormalities, such as kyphoscoliosis, can further restrict chest expansion and worsen respiratory function 1.
Management and Intervention
- Regular screening for dysphagia is recommended, starting from Hoehn and Yahr stage III, using self-report questionnaires such as the Swallowing Disturbance Questionnaire (SDQ) or the Munich Dysphagia test-Parkinson's disease (MDT-PD) 1.
- Exercise programs, including expiratory muscle strength training (EMST) and oral motor exercise programs, have been shown to improve cough and swallow function in PD patients 1.
- Speech therapy for swallowing and appropriate treatment of respiratory infections are essential interventions to improve quality of life and reduce morbidity in patients with parkinsonism 1.
- Early detection and management of dysphagia and respiratory complications are crucial to prevent aspiration pneumonia and improve outcomes in patients with parkinsonism.
From the Research
Effects of Parkinsonism on the Respiratory System
The effects of parkinsonism on the respiratory system are multifaceted and can lead to significant morbidity and mortality in patients with Parkinson's disease. Some key aspects include:
- Respiratory dysfunctions, such as obstructive ventilatory patterns and restrictive modifications, are common in Parkinson's disease patients 2, 3.
- Rigidity and kyphosis associated with Parkinson's disease can lead to respiratory impairments, and subsidiary pulmonary complications can arise as side effects of medication 2, 3.
- Silent aspiration can cause pneumonia in Parkinson's disease patients, highlighting the need for careful management of respiratory and swallowing functions 2.
Types of Respiratory Dysfunction
Various types of respiratory dysfunction have been observed in Parkinson's disease, including:
- Restrictive changes, mainly secondary to chest wall rigidity 3.
- Upper airway obstruction, which can be responsive to dopaminergic modulation 3.
- Respiratory dyskinesia, a side effect of levodopa therapy, which can produce both restrictive and dyskinetic ventilation 3.
- Pleuropulmonary fibrosis, a potential complication of therapy with ergot derivatives 3.
Impact of Levodopa on Respiration
Levodopa, a common treatment for Parkinson's disease, can have both positive and negative effects on respiration:
- Levodopa can improve respiratory function in some patients, but it can also induce respiratory dyskinesia and other complications 3, 4.
- A biphasic levodopa-induced respiratory dysfunction has been observed, where patients experience dyspnea and reduced respiratory muscle control when the effect of levodopa is subtherapeutic 4.
Respiratory Training and Management
Respiratory training can be an effective way to alleviate respiratory dysfunction in Parkinson's disease:
- Various respiratory training interventions, such as inspiratory muscle strength training, expiratory muscle strength training, and breath-stacking, have shown positive effects on respiratory muscle strength, swallowing safety, and phonatory aspects 5.
- Standardizing training devices, instruments to measure outcomes, and intervention protocols is necessary to further increase the level of evidence and improve respiratory management in Parkinson's disease patients 5.