Parkinson’s disease can affect many different parts of the body. But perhaps one of the scariest symptoms is when it starts to affect breathing. People with Parkinson’s may face various respiratory problems. Some are easier to treat than others. Here’s more information about which breathing problems may be related to Parkinson’s disease and what you can do about them.

1. Aspiration Pneumonia

People living with Parkinson’s disease have a higher risk of aspiration pneumonia. This is due to the disease’s effects on motor coordination, which is associated with dysphagia (swallowing difficulties). Aspiration pneumonia happens when food or fluid gets into the lungs. If left untreated, this causes a pneumonia infection.

Pneumonia is more common in advanced Parkinson’s disease than in the early stage because swallowing becomes more challenging with time. According to a recent study from 2021, 80 percent of people with Parkinson’s disease have trouble swallowing. This symptom generally gets worse as the disease progresses.

Trouble swallowing makes it more likely that foods and beverages will go down the windpipe instead of the throat. This is called aspiration. Aspiration promotes lung inflammation and makes breathing more difficult. It’s also a big risk factor for aspiration pneumonia.

Untreated aspiration pneumonia is the main cause of morbidity (death) for people with Parkinson’s disease. It can be diagnosed with a chest X-ray. Fortunately, doctors can treat aspiration pneumonia with antibiotics if caught in time. The person with Parkinson’s or a loved one should consider asking a health care provider the following questions:

• When and how often do we need to perform standard screening of swallowing abilities?
• What precautions or steps can help prevent aspiration pneumonia?
• What changes to the medication regimen can help manage swallowing difficulties, and when should I start exploring these options?
• Is there a standard protocol I should be aware of?

People who get aspiration pneumonia frequently can meet with a speech and language pathologist for help. They may suggest strategies like thickening liquids before drinking them to reduce the risk of aspiration.

2. Respiratory Dyskinesia

“Respiratory dyskinesia” refers to an involuntary lung movement. It causes rapid, shallow, and irregular breathing related to muscle spasms or tremors.

Being consistent with your Parkinson’s disease treatment plan can help minimize motor fluctuations that affect breathing. Studies show that people with Parkinson’s who stay on the medication levodopa have fewer respiratory problems than those who go off their medication.

However, respiratory dyskinesia can also be a side effect of levodopa — usually when levodopa reaches its maximum effect. If your medication causes respiratory dyskinesia, your doctor may consider adjusting your dose. Your health care team can help you find the right balance of medication to control your symptoms while avoiding side effects, thereby improving your quality of life.

3. Restrictive Lung Disease

When a person’s lungs cannot fully open up or expand, they can develop what’s called restrictive lung disease. Muscle stiffness from Parkinson’s disease can restrict chest muscles and slow down their movement. One MyParkinsonsTeam member said, “I have tightness and compression in my chest when I lie down. I’m gasping with shortness of breath when I try to speak more than three words at a time.”

People with Parkinson’s disease may also struggle to stand up straight. Hunching over can limit the lungs’ capacity to take in air.

“I sleep for two or three hours most nights. Then I wake up and cannot get back to sleep in bed due to problems with breathing,” said a MyParkinsonsTeam member. “I go to the living room and fall back to sleep in my electronically adjustable chair and can usually sleep another five or six hours due to a breathing problem. Sitting more erect helps.”

A doctor can diagnose restrictive lung disease by doing a pulmonary function test, which entails measuring the volume of air that a person can exhale after taking a deep breath. A round of steroids may be enough to treat restrictive lung disease in the short term. However, supplemental oxygen is a longer-term treatment option that’s sometimes also combined with inhaled steroids to prevent hypoxia (low blood oxygen levels).

4. Shortness of Breath

"Dyspnea" is the medical term for shortness of breath. It is a feeling of difficult or labored breathing that can make you feel as though you're not getting enough air, even at rest.

Shortness of breath can develop in people with Parkinson’s when their medication starts wearing off or doesn’t work as well as it once did. If you’re on the same medication and dosage for a long time, it may start to be less effective. This can affect the brain chemicals responsible for movement and memory, causing issues like shortness of breath. To avoid this complication, your health care provider may suggest changing your medication dose or schedule.

Another possible cause of shortness of breath is uncontrolled anxiety. Anxiety is a common symptom of Parkinson’s. It can cause physical responses that need to be managed. One MyParkinsonsTeam member described how shortness of breath and anxiety are a cycle. “Shallow breathing is scary. It makes me think I'm going to suffocate, which makes me stress more,” they shared.

Treatments for anxiety include:

• Speaking with a therapist
• Learning behavioral strategies
• Using anti-anxiety medication

Once you have a better handle on anxiety, you may notice a reduction in episodes of dyspnea.

5. Obstructive Sleep Apnea

Parkinson’s disease may affect muscle function in the airways and cause obstructive sleep apnea (OSA). With OSA, a person stops and starts breathing throughout the night. For some people with Parkinson’s, their brain isn’t able to adequately direct their body to breathe, due to Parkinson’s-related brain lesions.

OSA can lead to symptoms and complications such as:

• Excessive daytime sleepiness
• Loud snoring
• Abrupt awakening at night with gasping and choking
• Dry mouth when waking up
• Morning headaches
• Difficulty focusing or concentrating
• Mood changes leading to depression, anxiety, or irritability
• Complications such as poor memory
• Heart disease
• Stroke

To determine if you have OSA, your health care provider may recommend a sleep study, which typically includes a polysomnogram. During the sleep study, you will wear various sensors and electrodes that record your brain waves, oxygen levels, heart rate, breathing patterns, and muscle activity while you sleep. Once diagnosed, sleep apnea can be treated with a continuous positive airway pressure (CPAP) machine, which helps maintain open airways and improve respiratory function throughout the night. Discuss sleep posture, medication timing, and exercise options with your health care provider to help manage sleep apnea effectively.

Finding Solutions for Your Breathing Troubles

Members of MyParkinsonsTeam have reported feeling misunderstood by those who are not fully aware of the various symptoms associated with Parkinson’s disease. However, by advocating for themselves and communicating their concerns, they have been able to receive appropriate care and support. “I’m back to the local hospital today for another chest X-ray,” explained one member. “My general practitioner has no idea why my breathing is so bad, although I saw another provider yesterday who feels it could well be Parkinson’s or my Parkinson’s medication. Hooray! Finally, someone agrees with me.”

Parkinson's diagnosis comes with a lot of unpredictable changes and ongoing challenges. Understanding the potential complications and your treatment options can help you communicate with your health care team and take control of your health.

Talk With Others Who Understand

On MyParkinsonsTeam, the social network for people living with Parkinson’s and their loved ones, more than 102,000 members come together to ask questions, give advice, and share their stories with others who understand life with this neurodegenerative disorder.

Do Parkinson’s-related issues like the effects of levodopa impact your breathing? If so, how does respiratory dysfunction affect your daily life? What impact was the most surprising? Share your experience in the comments below, or start a conversation by posting on your Activities page.