Shortness of breath (dyspnea) is defined as a sensation of extreme breathing discomfort or breathlessness. It has been described as an intense tightening in the chest or ‘air hunger’ – the need for additional air or a feeling of suffocation. It can be scary and uncomfortable.
There are numerous causes of respiratory abnormalities that can make someone feel short of breath. The Mayo Clinic includes strenuous exercise, high altitude, obesity, and extreme heat as potential factors causing shortness of breath, even in healthy people. Other causes are generally related to a medical condition. In people with Parkinson’s, there can be several contributing factors for a physician to evaluate, ranging from medications to psychological conditions.
What is Parkinson’s disease?
Parkinson’s disease (PD) is a chronic, neurodegenerative disorder that is generally characterized by motor changes such as tremors, slowness of movement (bradykinesia), rigidity, and difficulty controlling movement. People with PD may experience motor, non-motor, and cognitive changes during the course of their disease. Parkinson’s has no known definitive cause or cure. Its onset occurs most commonly after age 60.
Dyspnea and respiratory distress are among the noted non-motor symptoms first described in 1817 by James Parkinson in his “Essay on the Shaking Palsy”. As it is often stated, Parkinson’s affects each person differently. You may not think certain symptoms are related to your Parkinson’s, so remember to keep a list and discuss them with your physician. Knowing that certain symptoms, like shortness of breath, can be connected to PD can make them less of a concern.
Clinical evaluation of shortness of breath
A physician should evaluate shortness of breath and any other breathing abnormalities. Potential causes of breathing difficulty include heart and lung conditions, which should be ruled out. People with PD often see general practitioners for medical care in addition to neurologists. It is important for such providers to be aware that PD and associated medications can cause shortness of breath.3
Contributing causes of shortness of breath
People with Parkinson’s may experience varied respiratory symptoms, ranging from shortness of breath without exertion to acute stridor, the sudden onset of high-pitched breathing sounds when taking a breath. Dysfunction can be caused by a variety of factors including physiological restrictive changes in the lungs, upper airway obstruction, and response to medications.1,3
Off episodes in Parkinson’s
Off episodes occur when people experience a range of symptoms as their medications wear off or stop working between doses. That can cause motor fluctuations, sensory and psychiatric changes, and other non-motor symptoms, one of which is shortness of breath. It is common among people with PD who have been taking levodopa for many years.
Respiratory dyskinesia/restricted breathing
This refers to irregular or rapid breathing. It can be caused by lung rigidity, muscle changes within the upper airways and chest wall, or stooped posture, and may occur when levodopa medications reach peak effectiveness.3,4,5
Anxiety is a common symptom of PD. The fight or flight response anxiety can trigger may result in feeling short of breath.
Aspiration pneumonia can develop when food or liquids go down the wrong pipe, into the lungs rather than the esophagus. This can make breathing uncomfortable. Difficulty swallowing, choking, and aspiration pneumonia are more prevalent in people with advanced stages of Parkinson’s.
Non-PD related health issues
Other, non-PD related health issues that can cause shortness of breath include conditions such as asthma and allergies, and lung and heart diseases.4
How to treat shortness of breath
Treating shortness of breath in people with Parkinson’s is dependent on identifying the cause. There is no specific therapy for shortness of breath.4 Your medical team can provide specific ways to address available treatments for the causes listed above.
Follow your doctor’s instructions on medication management and report any changes to your breathing comfort as soon as possible. Other steps to take, if applicable include:
Manage your weight
Manage general health and other medical conditions
Limit exposure to pollution and allergens1,4
Based on a review of medical literature, there is no clear thought on the underlying mechanisms that cause shortness of breath in Parkinson’s disease. There are no records of how common it is (prevalence) or the effect of medication—specifically levodopa—on respiration. Limited clinical research is available relating to this often-ignored non-motor symptom.3 Additional clinical studies may provide improved understanding and potential treatments.
Self-care. Available at: https://www.mayoclinic.org/symptoms/shortness-of-breath/basics/definition/sym-20050890. Accessed 12.11.18.
Yust-Katz, S., Shitrit, D. et al Respiratory distress: an unrecognized non-motor phenomenon in patients with parkinsonism. Available at: https://link.springer.com/article/10.1007/s00702-011-0671-0. Accessed 12.11.18
Breathing problems in Parkinson’s disease: a common problem, rarely diagnosed. Available at: https://atlasofscience.org/breathing-problems-in-parkinsons-disease-a-common-problem-rarely-diagnosed/. Accessed 12.11.18.
Breathing & Respiratory Difficulties. Available at: https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Breathing-and-Respiratory-Difficulties. Accessed 12.11.18.
Torsney, KM. Forsyth, D. Respiratory Dysfunction in Parkinson’s disease. https://www.rcpe.ac.uk/sites/default/files/jrcpe_47_1_forsyth.pdf. Accessed 12.11.18.
Khan, W. Rana, AQ. Shortness of breath, a 'wearing-off' symptom in Parkinson's disease. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19715385. Accessed 11.11.18