In this section you will find information and ideas for preventing and managing respiratory problems. Not all persons with advanced MS will develop respiratory problems; however, if they do, these problems can be serious and even life threatening unless Care Givers are educated and prepared. Being aware of what to look for, and knowledgeable of how to treat these problems, will give you greater confidence in preventing crises associated with the respiratory tract. It may be helpful to have good contact with your HSE Chartered Physiotherapist, Speech and Language Therapist and PHN; these can be sourced from your local health centre.
Once any of these are noted, your loved one’s GP should be notified immediately.
- Increasing frequency or difficulty swallowing foods and fluids.
- Food not being chewed well.
- Coughing becoming more frequent.
- Mucous from the mouth or nose no longer clear.
- Respirations becoming quicker and laboured.
- Increased fluid build-up.
- Fever develops (you should already know at what temperature your doctor wants to be notified).
- Complete obstruction of the airway, even if only one time, necessitating use of the Heimlich Manoeuvre.
Care Givers are often focused on the more common problems of MS such as spasticity, pain, mobility, and bladder and bowel impairment. It might only be when a person experiences a bout of pneumonia or has a choking episode that any attention is given to this area. Knowing the signs and symptoms of respiratory involvement is important in avoiding crises, and dealing with difficult situations when they arise.
- Pay attention to respirations. Are they quiet, clear, and unlaboured?
- How many breaths per minute does he/she take? The normal breaths per minute are usually in a range of 16 to 20.
- Pay attention to how all medications affect breathing (do certain medications make the person sleepy or lessen the number/depth of respirations?). If so, do not give anything to eat or drink until he/she is more alert.
- Encourage taking 10 deep breaths every hour to keep lungs clear.
- Buy an inexpensive stethoscope and just listen to the lung sounds. They should be clear all throughout the chest.
- If confined to bed, make sure the person is turned every 2 hours to improve oxygen flow.
- Watch for difficulty chewing and/or swallowing food.
- Keep sick individuals away (especially those with respiratory infections). If a Care Giver or a family member has a cold and must be in the same room, wear a mask.
- Annual flu and pneumonia vaccines should be considered.
- Have all family members who provide hands-on care take a course in CPR and learn the Heimlich Manoeuvre.
- Continue frequent deep breathing and coughing exercises.
- Continue to turn every two hours.
- Eliminate any foods that appear to cause chewing, swallowing, or choking problems.
- Change the diet to include either soft or blended foods. Do not include anything that requires much chewing. Seek advice from a qualified dietician on diet changes.
- Utilise a thickener to improve the ability to handle fluids such as soups and blended foods.
- Have the person sitting so that he/she swallows with less difficulty.
- If you feel uncomfortable with continuing food and fluids by mouth, tube feeding can be initiated in a hospital setting.
- If diagnosed with pneumonia, make sure all of the antibiotic is given. Do not stop, even if temperature returns to normal and no more abnormally coloured secretions are present.
- For very serious situations, obtain a bedside suction machine