Objective: To establish if pulmonary function is impaired in Parkinson’s disease (PD) and define any pattern of impairment.

Background: Parkinson’s disease (PD) is associated with excess morbidity and mortality from respiratory causes. Pulmonary function studies have yielded conflicting results in PD. Previous research, particularly in more recent years, on pulmonary function in PD has found high levels of restrictive spirometry. Most previous studies in PD based their diagnoses of restriction on spirometry alone, rather than whole body plethysmography (1). Poor instruction, poor technique and insufficient effort during spirometry can produce low values with a ratio diagnostic of restriction and thus give false positive results. Understanding the pattern of any respiratory dysfunction in PD is of importance in breathlessness, exercise limitation, upper airway dysfunction and impaired airway protection with consequent lower respiratory tract infections and pneumonia, acute and chronic respiratory failure, sleep disordered breathing, daytime somnolence, speech and swallowing.

Method: One hundred participants, Hoehn and Yahr stages I-IV, were recruited from the Northumbria PD service. They underwent assessments including demographics, questionnaires and comprehensive pulmonary function testing; spirometry, flow volume loops, lung volume assessment by whole body plethysmography and respiratory muscle strength testing.

Results: Of 64 non-smoking people with no known pre-existing lung disease, 28% had obstructive spirometry and up to 61% had at least one indicator of upper airway obstruction. Inspiratory muscle weakness was more severe than expiratory muscle weakness. Restriction was not a prominent feature with only 3 of 100 participants in this study demonstrating restrictive lung function (1 of which was based on spirometry alone).

Conclusion: The increased prevalence of obstructive spirometry, upper airway obstruction and inspiratory muscle weakness observed could lead to increased morbidity and mortality. Further research is warranted to assess the benefit of rehabilitation of the pulmonary system, both pharmacologically and non-pharmacologically.

References: 1. O’Callaghan A, Walker R. A review of pulmonary function in Parkinson’s disease. Journal of Parkinsonism and Restless Legs Syndrome. 2018;8:13—23

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