Understanding Respiratory Difficulties in Multiple Sclerosis

Breathing Problems That Can Be Caused By MS

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Respiratory problems can occur in advanced multiple sclerosis (MS). Generally, mild dyspnea (shortness of breath) during strenuous activity is more common in MS than severe respiratory impairment or difficulty breathing while at rest. But even mild breathing impairment can make you less energetic and may interfere with your ability to exercise or engage in taxing tasks.

It is important that you are aware of this potential effect of MS and that you discuss any concerns about your breathing with your healthcare provider.

Causes of Breathing Problems in MS
Verywell / Cindy Chung


Mild respiratory weakness can manifest with shallow breathing, which can be fast or slow. You may not notice this at first, as you might just consider it the way you normally breathe. Regardless, shallow breathing can make you feel run down.

Even fairly mild breathing problems can contribute to your MS-related fatigue and may make you feel that you aren't well rested, even after a full night's sleep.

Some other common symptoms of mild respiratory impairment include:

  • Shortness of breath; feeling that you don't have enough air
  • Hiccups
  • Cough
  • Frequent sighing

Your impaired respiration can contribute to a feeling of discomfort when you lie on your back, prompting you to sit up or change position so you can breathe a little easier.

If your MS begins to have a more substantial effect on your respiratory muscles, you can experience other symptoms, including:

  • Feeling that you are trying to breathe with a blanket over your head
  • Feeling as if you have a heavy weight on your chest
  • Being unable to take a deep breath


In general, MS-related breathing difficulties do not usually become life-threatening, but you can experience serious complications. For example, the feeling that you can’t get enough air can lead to panic attacks and severe anxiety.

In rare instances, respiration may become profoundly impaired, requiring assistance such as supplemental oxygen or ventilation support.


The severity of breathing problems in MS is closely related to that of the disease; the more advanced your MS, the more likely you are to have related breathing issues (and for them to be significant).

Breathing can be impaired by several factors in MS, including:

  • Muscle weakness: Motor weakness can affect any of your muscles when you have MS. The muscles that control breathing are not commonly affected by MS, but when these muscles are weak, it can take more effort to breathe deeply, especially when you are lying down on your back.
  • Medications: Some prescription medications used for MS-related pain or spasticity (muscle tightness or stiffness) can affect your breathing, making it slower and shallower. These include muscle relaxants, tranquilizers, and opioid-based pain medications.
  • Aspiration pneumonia: MS-related swallowing difficulties or inability to clear mucus from your nose or throat may lead to aspiration pneumonia, which can occur when liquid, mucus, and/or food particles enter the lungs and they become infected. It can take a while to recover from aspiration pneumonia, and breathing is often difficult if you have this condition.

With MS or other neuromuscular diseases, the compounded effects of pneumonia and respiratory impairment (even if you hadn't noticed it before) can make breathing a major challenge.


There are several tests that can help identify respiratory problems in MS. Your healthcare provider will measure your respiratory rate to determine whether your breathing rate is fast, slow, or normal. Rapid breathing and slow breathing can both occur as a result of MS-induced respiratory problems, and both are not healthy.

There are a number of pulmonary function tests that assess the strength of the muscles you use to breathe.

Spirometry is one of the simplest and fastest pulmonary function tests, and it measures the amount of air you can breathe in and out. For example, your forced vital capacity is the amount of air you can force out of your lungs with a maximal breath, and this volume is dependent on the health of your lungs and the muscles that control your breathing.

If there is any concern about an infection in your lungs or changes in the structure of your lungs, you may need a chest X-ray or a chest computerized tomography (CT) scan to help your healthcare providers visualize your lungs and the other structures in your chest.


Be sure to talk with your healthcare provider or physical therapist if you experience any symptoms of respiratory impairment. Prevention and/or treatment strategies may be recommended to you.


There are several treatment strategies that can help prevent respiratory problems and maximize your breathing if you have mild respiratory problems.

  • Minimize your risk of getting a respiratory infection: Avoid people when they have an infection, wash your hands, get your flu shot, and get enough rest. If you start feeling sick or if you develop a cough, contact your healthcare provider right away.
  • Eat softer foods and sit up while you eat to help prevent aspiration pneumonia. Likewise, avoid laughing hard or talking with your mouth full.
  • Respiratory therapy may include breathing exercises to improve overall respiratory function. If you do deep breathing exercises while your MS is mild, you may build lung strength, which can help prevent respiratory complications during later MS stages.

Keep in mind that your MS may remain mild and you may never advance to more severe MS or experience respiratory problems. But it is hard to predict your disease course, so taking precautions early on is better for your overall health.


If you develop severe respiratory impairment, you may need interventional treatment:

  • Nasal oxygen, especially during sleep, is usually used for people who have lung disease. However, if your breathing is affected by your MS, your healthcare provider may consider this option for you.
  • Respiratory support with a non-invasive ventilator or invasive mechanical ventilation is used for managing serious breathing impairment. While not typically needed in MS, these assistive devices may be necessary if you can't breathe adequately on your own. Your medical team may need to begin respiratory assistance to avoid a sudden or life-threatening emergency.

A Word From Verywell

Weak breathing compounded with overall reduced physical mobility and the risk of infections can predispose you to a prolonged illness from which it may be difficult to recover. Because of this, you need to be vigilant in terms of prevention of respiratory infections, maintaining regular exercise, and getting any breathing problems evaluated. While breathing problems are not common in MS, the potential for them is worth your attention.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Multiple Sclerosis Foundation. MS and breathing problems.

  2. Health Care Journey. Breathing and respiratory.

  3. Multiple Sclerosis Association of America. Anxiety.

  4. National Multiple Sclerosis Society. Breathing problems.

  5. Tzelepis GE, McCool FD. Respiratory dysfunction in multiple sclerosis. Respiratory Medicine. 2015;109(6):671-679. doi:10.1016/j.rmed.2015.01.018

  6. Fry D, Chiara T. Pulmonary dysfunction, assessment, and treatment in multiple sclerosis. Int J MS Care. 2010;12:97–104.

  7. American Lung Association. CT scan.

  8. Multiple Sclerosis Trust. Breathing problems.

  9. Drugs.com. Aspiration pneumonia.

  10. Hensen HA, Krishnan AV, Eckert DJ. Sleep-disordered breathing in people with multiple sclerosis: prevalence, pathophysiological mechanisms, and disease consequences. Front. Neurol. 2018;8:740. doi:10.3389/fneur.2017.00740

By Julie Stachowiak, PhD
Julie Stachowiak, PhD, is the author of the Multiple Sclerosis Manifesto, the winner of the 2009 ForeWord Book of the Year Award, Health Category.