Breathing Difficulties

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative condition characterized by progressive muscle weakness and wasting. In some cases, breathing difficulties are among the first symptoms of ALS, as the chest muscles and diaphragm that control breathing become affected by the disease. In other patients, breathing difficulties may only appear as the disease progresses.


Common symptoms of breathing problems reported in ALS patients are:

  • Increased breathlessness
  • Shortness of breath
  • Shallow breathing at night causing sleep interruptions
  • Breathing discomfort while speaking, sitting, or doing other activities
  • Weak cough
  • Excessive saliva production
  • Difficulty clearing mucus from the lungs and throat causing buildup and recurrent infections
  • Respiratory failure


The healthcare team — pulmonologist, respiratory therapist, and other specialists — will perform a detailed review of the patient’s medical records and symptoms to diagnose breathing problems.

They may also perform tests to measure muscle strength and lung function. Some of these tests include:

  • Spirometry to measure air movement through the lungs and determine lung health. Spirometry is used to measure vital capacity, or the amount of air exhaled after a deep breath intake. Different vital capacity parameters measured by spirometry are forced vital capacity (the amount of air forcibly exhaled after a deep inhalation), forced expiratory volume (the amount of air forcibly exhaled in one second), and slow vital capacity (the amount of air that can be slowly exhaled after a deep inhalation).
  • Sniff nasal inspiratory pressure and maximum inspiratory pressure, which measures the strength of the diaphragm muscle that helps in inhalation
  • Maximum expiratory pressure, which measures the strength of muscles in the abdomen that assist in inhalation
  • Pulse oximetry that measures oxygen levels in the blood
  • Capnography that measures carbon dioxide levels in the breath

Treatment and management

The occurrence and severity of breathing difficulty symptoms vary from patient to patient. Based on the symptoms, the healthcare team will develop a treatment and management plan specific to the patient.

The goals of treatment for breathing problems in ALS are to:

  • Improve lung function
  • Improve cough strength
  • Make breathing easier
  • Prevent lung collapse
  • Decrease the rate of lung infections
  • Decrease the dependence on mechanical assistance
  • Lower stress and anxiety

These can be achieved in different ways.


Maintaining good eating habits is vital to maintain proper lung function. Patients are advised to eat small portions and avoid sleeping immediately after a meal.

Sleeping position

Sleeping with the head slightly elevated can help improve breathing by allowing the abdominal muscles to move freely.

Breathing and coughing exercises

A trained pulmonary therapist can help with breathing exercises and coughing techniques.

A simple breathing routine such as taking 10 deep breaths with short rests in between can help improve breathing.

Coughing is vital to clear mucus from the lungs and the airways. Cough techniques such as breath stacking and huffing can help improve the movement of lung secretions.

Assistive devices

A respiratory therapist can also help patients with the use of assistive devices that can help them breathe better. Assistive devices include automatic mechanical cough assist machines and ventilators.


Medications may also be prescribed that can help open airways to ease breathing (bronchodilators) and loosen the mucus to make it easier to be removed by coughing (mucolytics).

As ALS patients may be prone to lung infections, it is recommended they are vaccinated against the flu and pneumonia. They should also avoid contact with people who have symptoms of the flu or a cold.


Last updated: Sept. 29, 2019


ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.