Did you know that myasthenia gravis can affect the muscles that control your breathing? Ultimately, the goal of treatment is to improve muscle function in efforts to minimize symptoms, especially ones that that involve chewing, swallowing, and breathing.
Unfortunately, some patients with myasthenia gravis can become so weak to where they require mechanical ventilation to breathe; this is known as a myasthenia crisis. A myasthenic crisis is a medical emergency that can be life-threatening and must be taken seriously.
The MGA often gets questions from patients about breathing issues, thus, we thought it would be wise to sit down with a respiratory therapist and learn more about our respiratory health. In honor of respiratory care week, we invited respiratory therapist, Jamie Kuiken, to elaborate on this relevant topic. Jamie works at Ottumwa Regional Health Center in CardioPulmonary Services and has a 43 year long career working as a respiratory therapist. She shares her insight below.
Jamie, can you give us a brief overview of what the respiratory system is, in the simplest of terms?
JK: Sure. As our blood travels through our body, it provides oxygen to our organs, muscles and tissues. Carbon dioxide is produced and returns to the right side of the heart. Then the blood is pumped into the capillaries of the lungs where it meets with the tiny air sacs called alveoli. The CO2 leaves the capillaries and is exchanged for Oxygen. The blood returns to the left side of the heart and is pumped around the body. We breathe in fresh air and expire the CO2.
Interesting. So, as a respiratory therapist, how are you involved in a patient’s medical care?
JK: I have been a respiratory therapist for 43 years. Anything that has to do with breathing is my thing! From premature babies who need support, to emergency room situations, we cover it all. For the last 10 years I have concentrated my efforts in Pulmonary Rehabilitation.
What an important job you have. I’m sure you see all kinds of things. Are there certain conditions that you regularly see and treat? Better yet, what are some of the common symptoms you run into when you work with patients?
JK: Most of the patients I see have trouble with air exchange in the lungs due to a barrier between the lungs and the capillaries that exchange carbon dioxide for fresh air (Oxygen). This may be pneumonia which blocks the airways with mucus, chronic obstructive pulmonary disease (COPD) where small airways weaken and collapse, trapping air in the alveoli, pulmonary fibrosis, or most recently, Covid-19 with very thick tenacious mucus.
Ironically, since we are talking about myasthenia gravis, the opposite of these problems are the cause of shortness of breath. When most of our patients start rehab, I preface their introduction by saying, “We can’t change your lungs, but we can improve your cardiovascular system and muscle strength, which will improve your breathing.” With myasthenia gravis, muscle strength due to nerve transmission is the cause of the problem.
That is fascinating! So, for people with myasthenia gravis, their muscles may become so weak that they may require mechanical ventilation, better known as a myasthenia crisis. Could you expand upon what may be happening physically to someone who is having respiratory muscle weakness and what steps a patient’s medical team may take to prevent a person from heading into respiratory failure?
JK: A crisis of myasthenia gravis may come on quickly. A person may not have a gag reflex or are unable to cough. Rapid shallow breathing may be present. Suction of secretions and supplemental oxygen may help. Poor respiratory effort is a signal that they need to be transported to the hospital and have breathing supported either by BiPAP or intubation and ventilator.
As alarming as that sounds, it is so important to know. In efforts to prevent this from even occurring, how do healthcare providers assess an MG patient’s pulmonary function/respiratory health?
JK: If a patient is not in obvious crisis, a pulmonary function test would be done, pulse oximetry (O2 sat of 90-93%), Peak expiratory flow, negative inspiratory force, and arterial blood gas (ABG). Many people now own a pulse oximeter and a peak flowmeter to test at home and recognize a potential problem.
That’s nice to know that people can also take steps to monitor their own health. Are there any effective treatments for respiratory problems? What other things can patients do to ensure they have a healthy respiratory system?
JK: Respiratory therapists have usually been more involved with acute symptoms, when a person is in crisis, to support breathing, until the patient has been stabilized with medications and immunosuppressive drugs or plasmapheresis.
Traditionally, it was believed that physical exercise could exacerbate symptoms for MG patients. However, recent studies have shown that twice weekly resistance training improved muscle strength and functional capacity (significant improvement on 6-minute walk and sit-to stand test).
Do you have any tips or things to keep in mind that would help MG patients with regard to their respiratory health?
JK: I would highly recommend mild exercise with light resistance training. I cannot stress the importance of anti-inflammatory foods enough. We have seen tremendous improvement is outcomes with patients in pulmonary rehab in not only physical heath, but in every aspect of their life.
*MGA Disclaimer: Patients with myasthenia gravis should always speak with their medical care provider regarding exercise and nutrition. Every patient is different and this is not intended to be a substitute for medical advice.