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Shortness of breath can be a sign of myasthenia gravis (MG) or a complication of the disease. MG affects the neuromuscular junction, where nerves and muscles communicate. This can cause muscle weakness, including in the respiratory muscles you need to breathe.
Members of MGTeam have discussed experiencing shortness of breath with MG. “Sometimes, I get short of breath unexpectedly,” shared one member. “But usually I’m tired, have a slight cold or virus, or have had an extra stressful day.”
When unexplained breathing problems occur or get worse, they should be evaluated promptly by your medical provider. Read on to learn what causes shortness of breath in people living with MG. You’ll also find some tips to ease the symptom.
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Some situations or factors are triggers that worsen symptoms of MG. Shortness of breath can also be a sign of dangerous MG complications, such as myasthenic crisis or cholinergic crisis.
A myasthenic crisis is a worsening of symptoms that makes the respiratory muscles too weak to move enough air in and out of the lungs. Between 10 percent and 20 percent of people living with generalized MG have a myasthenic crisis at least once in their lifetime. Generalized MG is the type that affects multiple muscle groups beyond the ocular (eye) muscles.
Myasthenic crisis is a life-threatening emergency that requires immediate medical treatment. From 66 percent to 90 percent of people in a myasthenic crisis need intubation, in which a tube is placed into the airway, and mechanical ventilation to help them breathe.
More than 20 percent of people with myasthenic crisis need intubation when they’re first evaluated at an emergency room. Nearly 60 percent are intubated after being admitted to an intensive care unit (ICU).
A myasthenic crisis can be triggered by several factors, including:
No specific trigger is found in 30 percent to 40 percent of people in a myasthenic crisis.
A cholinergic crisis is an uncommon complication that can seem similar to a myasthenic crisis. Both can result in trouble breathing. The most common cause is having too much of an acetylcholinesterase (AChE) inhibitor in the body, which can happen if the dose is too high or the medication builds up in the system.
Treatment for a cholinergic crisis can include:
Breathing difficulties can be uncomfortable or scary. Fortunately, there are steps you can take to breathe easier if you’re living with MG.
Work with your doctor to find the best medications to manage your symptoms, including shortness of breath. Your doctor may recommend medications like:
Your doctor will choose medications based on factors such as your antibody status, age, and how severe your disease is. They’ll tell you how they work and what to expect while taking them.
While managing MG, be cautious of certain medications that can trigger a myasthenic crisis. You may need to avoid certain drugs or work with your healthcare team to find safer alternatives.
Make sure your doctors and pharmacist know that you have MG. That way, they can help you avoid dangerous drug interactions.
One study found that people with MG have a 39 percent higher infection risk compared with those who don’t have the condition. Infections are the most common trigger of a myasthenic crisis.
Taking steps to avoid contact with people who have a cold or flu can help you avoid respiratory infections. Proper hand-washing and hygienic practices also help to fight the spread of germs.
MG treatment typically includes using immunosuppressive drugs. These make it harder for the body to fight infections. If recurrent infections become a problem, your doctor can help you manage your medications to best suit your needs.
Another side effect of AChE inhibitors is an increase in mucus production. More mucus can increase the infection risk, which may lead to worsening breathing problems.
Research has shown that exercise may help with shortness of breath in people with stable MG. One exercise program included aerobic cycling, resistance training exercises such as squats and jumps, and stretching exercises. After participating in this exercise program, the people in the study showed improved lung function.
Another exercise program consisted of aerobic activity, resistance strength exercises, and balance and stretching exercises. After completing this program, participants showed improved strength and aerobic performance. They also reported an improvement in their MG symptoms.
While exercise is great for your body, people with MG should take extra precautions due to the nature of the disease. Muscles in people with MG fatigue more quickly with repeated use. Exercise is still recommended, but it’s essential to take more breaks during your session.
Keep in mind that exercise isn’t a solution for worsening breathlessness in MG. Always talk to your doctor about personalized treatment for worsening breathing symptoms.
Just like general exercise, training the muscles responsible for breathing can also be helpful. People with MG often have decreased respiratory muscle strength and endurance. Improving the function of these muscles may help improve breathing.
One exercise program used intervals to account for the muscle fatigue that can occur with repeated activity in people with MG. It included using a respiratory trainer device with different pressure levels tailored to the person. After 12 weeks of training, participants reported improvements in lung function, endurance, and cardiovascular capacity.
Respiratory muscle training may help improve the function of the lungs and the muscles linked with breathing. But you should reach out to your doctor for personalized care if you have new or worsening breathing problems.
Stress can be a major trigger for a myasthenic crisis. Stress can come in many forms, including physical, environmental, and emotional stress.
“Stress is a huge trigger,” a member of MGteam said. “I’m learning my triggers and my limits. My daughters and I are putting together a tracking form for myself to find patterns of my symptoms.”
Another member talked about their crises being triggered by major life events. Examples included losing a spouse or having to return to work to pay the bills.
It’s crucial to recognize and manage stress before it becomes overwhelming. Taking rest breaks during tasks can help reduce physical stress. Completing larger tasks earlier in the day can help manage energy demands.
To help manage emotional stress, some people find it helpful to talk with a therapist or counselor. Others prefer confiding in friends and family.
Journaling can be another way to ease stress. Support from others with MG can be helpful as well, either from an in-person support group or an online community like MGteam. It might take some time to discover what works best for you.
Not every trigger for MG symptoms is avoidable. But knowing what might trigger a breathing crisis and how to respond can help you manage shortness of breath.
Work closely with your healthcare provider to address any questions or concerns about shortness of breath and MG.
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That was really helpful ,I did end up in hospital with breathing difficulties just before xmas and was put on an increased dose of prednisone which helped a lot and adjustments to my medication which… read more
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