Multiple Sclerosis (MS) can be complicated with respiratory dysfunction, and particularly expiratory muscle weakness, requiring ventilatory and secretion management support. We sought to characterise the MS cohort at a tertiary ventilation centre. A retrospective review of MS patients admitted to our centre between 01/2015 and 01/2021 was conducted.

We identified 30 adults (50% male) admitted for respiratory review. MS subtypes included primary progressive (59%), secondary progressive (27%) and relapsing-remitting (14%). Time from initial MS diagnosis to referral was 22±12yrs, while age was 57±11years. At baseline, BMI was 29±11kg/m2, peak cough flow 74±39L/min, FEV1: 1.06±0.65L, FVC: 1.37±0.72L, 4%ODI: 13±18events/hr, and overnight transcutaneous CO2: 45.3±6.52mmHg. Following assessment, 46% were initiated onto positive airway pressure (PAP) therapy (58% on pressure support, 29% on pressure control, 13% on continuous positive airway pressure), 25% onto mechanical insufflation-exsufflation (MIE) and 29% onto both. Survival after review was: 1-yr(100%), 2-yr (83.3%) and 5-yr(63.3%). Median time to death from referral was 5.2(4.2,7.5)yrs. The combination of PAP and MIE resulted in longer survival time (8.3[4.8,11.7]) compared with PAP alone (4.6[2.4,6.8]; p=0.03).   

In MS patients, respiratory compromise and consequent referral to a tertiary ventilation service is a late feature of the disease. Average survival following onset of respiratory compromise is more than half a decade. The combination of PAP and MIE appears to increase survival compared with PAP alone.