Signs and symptoms of respiratory impairment
This information is for health and social care professionals. You may also want to see our information for people living with or affected by MND on:
Motor neurone disease (MND) is a progressive and terminal disease that attacks the motor neurones, or nerves, in the brain and spinal cord. Respiratory muscle weakness occurs eventually in everyone with MND and ventilatory failure is the most common cause of death.
Most commonly, respiratory symptoms occur as the condition progresses. However, very occasionally, acute respiratory problems are the presenting feature of MND with a diagnosis made after an acute admission to hospital.
Early referral to a respiratory specialist is vital if one or more of these occur:
- Recurrent chest infections
- Disturbed sleep
- Non-refreshing sleep
- Daytime sleepiness
- Poor concentration and/or memory
- Morning headaches
- Increased respiratory rate
- Shallow breathing
- Weak cough
- Weak sniff
- Abdominal paradox (inward movement of the abdomen during inspiration)
- Use of accessory muscles of respiration
- Reduced chest expansion on maximal inspiration
People with MND may not complain much of breathlessness and, as they often lack mobility, signs of breathlessness due to exertion may be subtle. Night-time symptoms are often an early indicator of respiratory inefficiency. Ineffective breathing when lying down at night (orthopnoea) can lead to an imbalance in blood gases and a build-up of carbon dioxide (CO2).
As a result, the person with MND may:
- complain of waking with a headache, feeling unrefreshed or 'hungover' and not having slept well
- fall asleep during the day
- be difficult to rouse from sleep
- seem confused when they wake up.
The person’s partner may have noticed more laboured or shallow breathing patterns or apnoeic episodes during sleep.
Note: people with MND may also experience problems with sleep resulting from reduced mobility, muscle cramps, swallowing problems and anxiety.