Healthy eating
It is important to eat a sensible, balanced diet. Obesity should be avoided as it impedes breathing and increases the work of the respiratory muscles. It may also increase a tendency to obstructive sleep apnoea. Remember that it is always easier to prevent obesity than to lose weight! Constipation leading to abdominal distension is not only uncomfortable but reduces diaphragm movement. It is best dealt with by a good fibre intake, although sometimes mild laxatives are needed.
Influenza and pneumococcal vaccine
The influenza (flu) and pneumococcal vaccines are recommended for individuals with breathing problems. These vaccines are not 100% effective, but will significantly reduce the risk of infection. The influenza vaccine is given once a year, usually in October. The pneumococcus bacterium is one of the most common causes of bacterial pneumonia. The pneumococcal vaccine lasts about five to eight years and in some people does not need to be repeated as protection remains long term. Both vaccines can be given by your GP and are very safe, however individuals who are allergic to eggs should not receive them.
Breathing exercises and physiotherapy
Deep breathing helps to fully inflate the lungs and puts the lungs, respiratory muscles and chest wall through a good range of movement. Assisted coughing or ‘huffing’ is especially beneficial in clearing secretions at the time of a chest infection. Huffing is achieved by taking a few deep breaths and then forcing the air out as rapidly as possible with the mouth open. Phlegm is shifted from deep within the lungs to the main airways and then can be expectorated more easily. A family member or friend can help expand the chest in this region by placing their hands over the lower rib cage. Your physiotherapist will advise on breathing exercises and other forms of treatment if appropriate, such as postural drainage and chest clapping if secretions are excessive. Cough assist devices such as the In-Exsufflator may be of value in some individuals with a weak cough (see below).
Confidence about breathing can be boosted by breathing control advice and activities such as singing and playing the musical instruments like the recorder. Some respiratory muscle training devices have been developed, but evidence to support respiratory muscle training is not conclusive.
Posture and curvature of the spine
Good posture is essential to allow the rib cage to expand optimally. It requires attention in the sitting, lying and standing positions. For wheelchair users appropriate special seating not only improves posture and comfort but may prevent the development of skeletal deformity. Around half of boys with Duchenne muscular dystrophy develop a significant curvature of the spine (scoliosis) and a scoliosis is relatively common in other neuromuscular disorders which arise before adolescence. Surgical correction of the scoliosis is used in some individuals to stabilise the spine and prevent further loss of lung volume. However spinal surgery does not prevent further loss of lung capacity when it is caused by progressive muscle weakness.