Based on NIH | Is shortness of breath a symptom of Parkinson’s disease, and how is it assessed and managed?

Shortness of breath can occur in Parkinson’s disease (PD), although it is not among the classic motor symptoms and is often under‑recognized. Breathing complaints may stem from stiffness and slowness of the chest wall muscles, upper‑airway involvement, abnormal breathing control, medication effects, swallowing problems, or coexisting conditions. ^{[1] [2] [3] [2] [4]}

Is shortness of breath part of Parkinson’s?

• Possible non‑motor feature: Dyspnea (shortness of breath) and respiratory distress have been reported as non‑motor phenomena in parkinsonism, even when heart and lung tests are otherwise normal. ^[3]
• Mechanisms that can contribute: PD and related syndromes can lead to a stiff chest wall that resists quick movement, poor coordination of breathing muscles, and sometimes upper‑airway obstruction or disordered ventilatory control. ^{[1] [2]}
• Complications linked to PD: Swallowing problems and reduced mobility can increase the risk of aspiration (food or liquids going into the lungs) and pneumonia, which can present with shortness of breath. ^{[4] [5]}

Why breathing problems happen in PD

• Chest wall rigidity and bradykinesia: The thorax can be “stiff” and over‑expanded at rest with reduced ventilatory capacity, making breathing feel effortful, especially with activity. ^[1]
• Upper‑airway dysfunction: Abnormal movement or rigidity of laryngeal muscles can narrow the airway; in related disorders (e.g., multiple system atrophy), this can be severe. ^[2]
• Central control changes: Disruption in brainstem breathing rhythm and poor coordination of the diaphragm can cause a sensation of air hunger without clear lung disease. ^[3]
• Medication effects: Levodopa has rarely been linked to respiratory dysfunction (e.g., dyskinesia affecting respiratory muscles or altered ventilatory control), and ergot‑derived dopamine agonists can cause pleural/pulmonary fibrosis. ^[2]
• Swallowing impairment: Difficulty swallowing may lead to aspiration and pneumonia, both of which can cause shortness of breath. ^[4]

Red flags that need urgent care

• Sudden chest pain, blue lips, severe breathlessness at rest, new confusion, or fever should be treated as emergencies because they may indicate pneumonia, pulmonary embolism, heart attack, or airway obstruction.
• No single symptom should be assumed to be from PD until other serious causes are excluded.

How clinicians assess shortness of breath in PD

• History and medication review: Timing with “on/off” periods, relation to exertion or posture, swallowing difficulty, choking, cough, snoring/stridor, and recent medication changes (especially levodopa or ergot agonists). ^{[2] [4]}
• Physical and neurologic exam: Look for chest wall rigidity, use of accessory muscles, upper‑airway sounds (stridor), orthostatic blood pressure drops, and signs of aspiration. ^{[1] [2] [6]}
• Basic cardiopulmonary workup: Pulse oximetry, chest X‑ray, ECG, and labs to rule out heart failure, pneumonia, anemia, or pulmonary embolism, since these are common non‑PD causes of dyspnea.
• Pulmonary function tests (PFTs): Assess for a neuromuscular pattern of impairment and check for upper‑airway obstruction (flow‑volume loops). ^[2]
• Swallowing evaluation: Bedside screen and, if needed, videofluoroscopic study to detect aspiration risk. ^[4]
• Sleep and airway evaluation: If there is nocturnal choking, stridor, or excessive daytime sleepiness, consider sleep study and ENT assessment. ^[2]
• Response to levodopa: Observing whether breathing improves or worsens with dopaminergic dosing can help differentiate medication‑related effects. ^[2]

Management: multi‑pronged and individualized

Because multiple factors can drive dyspnea in PD, treatment often combines several approaches. Addressing life‑threatening or reversible causes (e.g., pneumonia, heart issues, medication side effects) comes first. ^{[4] [2]}

Optimize Parkinson’s and medications

• Adjust dopaminergic therapy: If respiratory symptoms align with levodopa peaks (suggesting dyskinesia of respiratory muscles) or with “off” periods (rigidity/akinesia of chest wall), clinicians may adjust dose timing or formulation. ^[2]
• Review ergot agonists: If used, evaluate for pleural or pulmonary fibrosis; discontinuation may be considered if implicated. ^[2]

Respiratory and rehabilitation strategies

• Breathing and posture therapy: Physical therapy and respiratory therapy can target chest wall mobility, diaphragmatic breathing, and posture to improve ventilatory capacity in a “stiff thorax.” ^[1]
• Aerobic activity as tolerated: Regular, paced exercise helps maintain chest wall flexibility and overall conditioning, with rest as needed to avoid overexertion. ^[7]
• Speech/swallow therapy: Techniques to improve swallowing and cough effectiveness lower aspiration risk and may reduce pneumonia‑related dyspnea. ^{[7] [4]}

Manage upper‑airway or sleep‑related issues

• ENT evaluation for stridor or suspected laryngeal dysfunction and consideration of therapies ranging from vocal fold procedures to airway support when indicated. ^[2]
• Sleep disordered breathing management: If sleep study confirms obstructive events, standard treatments (e.g., CPAP) may be used, adapted to PD needs. ^[2]

Aspiration and pneumonia prevention

• Swallowing strategies and diet modification can reduce aspiration; prompt treatment of suspected infections is important to prevent worsening breathlessness. ^{[4] [7]}

When to consider specialized care

• Multiple system atrophy (a related condition) can present with severe upper‑airway problems and poor response to standard PD medicines, so persistent stridor or rapid progression warrants specialist evaluation. ^[2]

---

Key takeaways

• Shortness of breath can be a PD‑related non‑motor symptom, often due to chest wall rigidity, upper‑airway dysfunction, or altered breathing control, but other cardiac or pulmonary causes must be ruled out. ^{[3] [1] [2]}
• Assessment is comprehensive, combining history, exam, cardiopulmonary testing, PFTs, swallowing evaluation, and medication review. ^{[2] [4]}
• Management is individualized, focusing on optimizing PD therapy, rehabilitation, airway and sleep evaluation, and aspiration prevention. ^{[1] [2] [7] [4]}

If you’d like, I can help you build a simple checklist to discuss with your neurology or primary care team, including which tests and therapy referrals might be most useful for your specific symptoms.