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Respiratory Problems in Post-Polio Syndrome
Dr. Marshall Reilly
Consultant Respiratory Physician
Belfast City Hospital
Post-Polio
• Previously involved muscle groups• People who had polio in later
childhood or as adults
• Muscle weakness• Fatigue
O2
CO2
Respiratory Centres
Scoliosis
Hypoventilation
Symptoms of hypoventilation
• Breathlessness• Daytime sleepiness• Morning headache• Reduced intellectual function• Reduced quality of life
But frequent underestimation of symptoms
Respiratory failureNormal Type I
(pneumonia, asthma)
Type II (nerve, muscle, chest wall)
Oxygen 12 kPa 6 kPa 6 kPa
Carbon dioxide
5 kPa 3 kPa 8 kPa
Types of Ventilation
• Negative pressure ventilation
• Positive pressure ventilation– invasive– non-invasive (NIV)
• Copenhagen 1950’s – Polio outbreak resulted in first use of positive pressure ventilation
• Early 1980’s - Long-term positive pressure ventilation via tracheostomies
• Late 1980’s Rideau et al and Delaibier et al both showed successful treatment of DMD and polio associated respiratory failure with nasal positive pressure ventilation
Positive pressure Non-Invasiveventilation
Case history
• Short of breath
• Morning headaches lasting for 2 hours or so after awakening
• Sleepy during the day
• General tiredness
• Scoliosis
Establishing ventilation
Admit to hospital for 3-4 days
• Accommodate to mask
• Use intermittently during night
• Tolerate most of night
• Education for patient and relatives/carers
Change in Blood Gases with nocturnal non-invasive ventilation
13/8/01 16/8/01 4/3/08
pO2 (kPa) 5.5 6.8 9.2
pCO2 (kPa) 7.52 6.98 6.2
Non-invasive evaluation of oxygenation
At review
• Much better
• No longer sleepy
• Headaches gone
• Able to do the shopping, go on holiday, enjoy life again
Efficacy of NIV
X
NMD
OBS
CWD
< 4hrs NIV
Nickol et al 2002i.e. aim for > 4hours use
Consensus Report - Chest 1999; 116:521-534
Chronic Noninvasive ventilation• Restrictive chest wall disease: scoliosis thoracoplasty obesity/hypovent• Stable neuromuscular: post polio myopathies neuropathies
spinal muscular atrophy• Progressive neuromuscular Duchenne MD MND/ALS• Neurological CCHS Spinal cord lesions CVA• Airway diseases
Disease Categories in Europe
0%
20%
40%
60%
80%
100%
Lung/airways Thoracic Cage NeuromuscularLloyd Owen 2005
Survival: Probability of continuing domiciliary NIV
Simonds Thorax 1995
Other issues
• Flu & pneumonia vaccination
• Avoid sedative medication
• Prompt antibiotics
CONCLUSIONS
• Noninvasive ventilation can reverse hypoventilation in patients with neuromuscular disease
• Let your doctor know if you develop any of the symptoms of respiratory failure
Symptoms of hypoventilation
• Breathlessness• Daytime sleepiness• Morning headache• Reduced intellectual function• Reduced quality of life
But frequent underestimation of symptoms