What is Respiratory Dyskinesia and How is it Managed?

Dyskinesia–the involuntary, uncontrolled, dance-like movements that many people with Parkinson’s experience–can affect any part of the body. When the muscles involved in breathing are impacted, it is called respiratory dyskinesia.

If you experience respiratory dyskinesia, your breathing may be irregular and possibly painful, especially shortly after a dose of Parkinson’s medication. You might also feel that your breathing is shallow and rapid, and you might experience uncontrolled or surprising inhalations or exhalations. 

Respiratory dyskinesia is relatively rare, and it is unlikely—but not impossible—that you would experience dyskinesia in muscles associated with breathing but not in other muscles. Also, because of the pain that may be involved in respiratory dyskinesia, it can be difficult to distinguish from dystonia affecting the muscles involved in breathing.

Causes of Respiratory Dyskinesia 

Parkinson’s impacts your brain’s ability to produce and process dopamine, a neurotransmitter involved in controlling muscle movements. Early on, muscles affected by Parkinson’s tend to be in your arms, legs, hands, and feet. As Parkinson’s progresses, the muscles involved in breathing can also be affected. Like other muscles, these muscles can be involved in dyskinesia. 

Dyskinesia associated with Parkinson’s is often influenced by medications. In fact, dyskinesia in Parkinson’s is often referred to as “levodopa-induced dyskinesia.” This is because fluctuations in effectiveness of levodopa, which tend to occur more frequently the longer a person lives with Parkinson’s, can contribute to dyskinesia. Regarding respiratory dyskinesia in particular, in a 2002 article, researchers write that overtreatment with levodopa can contribute to respiratory dyskinesia. They also observe that respiratory dyskinesia can be difficult to distinguish from other complications of Parkinson’s.  

Other respiratory and chronic conditions like asthma, sleep apnea, or chronic obstructive pulmonary disease (COPD) can also contribute to the development of respiratory dyskinesia. These pre-existing conditions can make it harder for the respiratory muscles to work normally and contribute to these muscles being involved in dyskinesia.   

Age and time living with Parkinson’s are additional risk factors for dyskinesia, including respiratory dyskinesia.

Management of Respiratory Dyskinesia

If you have trouble breathing that involves acute confusion, dizziness, loss of consciousness, or if your difficulty breathing causes significant fear or anxiety, you should seek medical advice and care immediately. 

Even if your respiratory difficulties are not as complicated as described above, you should consult with a member of your Parkinson’s care team to determine the best treatment path. Importantly, the erratic breathing involved in respiratory dyskinesia may increase your risk of aspiration. If you think you may be experiencing respiratory dyskinesia, it is critical that you mention it to your care team. 

Respiratory dyskinesia is complex and can be difficult to differentiate from other aspects of Parkinson’s, so in preparation to talk with your care team, it may be useful to take notes. Include medication timing and when you start experiencing issues involving your breath in your notes. One reason for tracking these details is that respiratory dyskinesia and dystonia may be difficult to distinguish from each other. If you experience painful or difficult breathing as your doses begin to wear off, this could be a sign you are experiencing dystonia not respiratory dyskinesia.

The following treatment strategies have shown positive effects in managing respiratory dyskinesia:  

Medication Adjustments

Adjusting the dosage or changing your Parkinson’s medications can help control respiratory dyskinesia. Adding an extended-release formulation of carbidopa/levodopa is one possible change. Adding a COMT inhibitor is another option you might explore with your care team. 

Adjusting the timing of your doses may help, too.

Advanced Treatments

When the medications adjustments are not enough, you might consider an advanced treatment like Deep Brain Stimulation (DBS), Duopa, focused ultrasound, or a continuous infusion levodopa formulation. There is a case study indicating that DBS can have a positive impact on respiratory dyskinesia, and advanced treatments often help improve medication efficacy and can help decrease dyskinesia.  

Respiratory Therapy

Respiratory therapists and speech language pathologists can help you strengthen your respiratory muscles, control breathing patterns, and help you avoid aspiration and other complications related to breathing. These interventions often target improving lung capacity and making strengthening muscles.

Because of the involvement of medication in the onset of respiratory dyskinesia, exercises may be less effective than medication adjustments in helping manage respiratory dyskinesia.

Take a Multidisciplinary Care Approach

Respiratory dyskinesia is a challenging impact of Parkinson’s disease. To ease symptoms and avoid complications, it’s important for you to share your experience with your care team. Due to the complicated ways that Parkinson’s can affect breathing, these impacts must be evaluated and managed by a comprehensive care team involving your neurologist, therapists, and possibly a pulmonologist. 

With this in mind, it is never to early to establish a relationship with a speech language pathologist, occupational therapist, and physical therapist, all of whom may be able to help evaluate and address issues with breathing before these issues become especially problematic. 

Additional Resources   

What is Parkinson’s Dyskinesia? 

Respiratory Abnormalities in Parkinson’s: What Do We Know from Studies in Humans and Animal Models? 

How to Find a Speech Language Pathologist