Respiratory Problems in Post-Polio Syndrome

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Respiratory Problems in Post-Polio Syndrome

• Dr. Marshall Reilly
• Consultant Respiratory Physician
• Belfast City Hospital

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Post-Polio

• Previously involved muscle groups
• People who had polio in later childhood or as
  adults
• Muscle weakness
• Fatigue

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O2
CO2
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Respiratory Centres
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Scoliosis
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Hypoventilation
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Symptoms of hypoventilation

• Breathlessness
• Daytime sleepiness
• Morning headache
• Reduced intellectual function
• Reduced quality of life
• But frequent underestimation of symptoms

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Respiratory failure
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Types of Ventilation

• Negative pressure ventilation
• Positive pressure ventilation
• invasive
• non-invasive (NIV)

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Positive pressure Non-Invasive ventilation

• Copenhagen 1950s Polio outbreak resulted in
  first use of positive pressure ventilation
• Early 1980s - Long-term positive pressure
  ventilation via tracheostomies
• Late 1980s Rideau et al and Delaibier et al both
  showed successful treatment of DMD and polio
  associated respiratory failure with nasal
  positive pressure ventilation

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Case history

• Short of breath
• Morning headaches lasting for 2 hours or so after
  awakening
• Sleepy during the day
• General tiredness
• Scoliosis

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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

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Change in Blood Gases with nocturnal non-invasive
ventilation
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Non-invasive evaluation of oxygenation
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At review

• Much better
• No longer sleepy
• Headaches gone
• Able to do the shopping, go on holiday, enjoy
  life again

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Efficacy of NIV
NMD OBS CWD lt 4hrs NIV
X
Nickol et al 2002
i.e. aim for gt 4hours use
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Consensus Report - Chest 1999 116521-534
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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

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Disease Categories in Europe
Lloyd Owen 2005
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Survival Probability of continuing
domiciliary NIV
Simonds Thorax 1995
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Other issues

• Flu pneumonia vaccination
• Avoid sedative medication
• Prompt antibiotics

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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

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Symptoms of hypoventilation

• Breathlessness
• Daytime sleepiness
• Morning headache
• Reduced intellectual function
• Reduced quality of life
• But frequent underestimation of symptoms