Pulmonary muscle weakness is a symptom of multiple sclerosis (MS) that begins early in the disease process, although it is often not recognized by health-care providers until later stages. Standard pulmonary function tests are not effective in detecting this reduction in pulmonary muscle strength. Maximal inspiratory and expiratory pressures are indirect measures of pulmonary muscle strength that are effective in detecting early changes. Once detected, pulmonary muscle weakness is effectively treated with pressure threshold load inspiratory and expiratory muscle exercises that can be implemented using inexpensive handheld pressure threshold load muscle training devices. These exercises require little time and are effective in patients with any level of disability.
From the Physical Therapy Department, School of Health Professions and Studies, University of Michigan–Flint, Flint, MI, USA (DF); and Malcom Randall Veteran Affairs Medical Center, Gainesville, FL, USA (TC).