Ask Linda

by Linda Wobeskya, M.S., P.T., GBPPA Member

This column originally appeared in the Fall, 2002 issue of TRIUMPH.

Dear Linda,
Iíve heard a lot of polio survivors have undiagnosed respiratory problems. I never needed to be in an iron lung, so I think Iím OK. How can I find out for sure?
Wondering in Weymouth

Dear Wondering,
Many polio survivors do in fact have respiratory problems that may go undiagnosed. Polio survivors may be at risk for respiratory problems, regardless of the prior use of an iron lung. To understand the relationship between polio and breathing, letís first look at the muscles we need to breathe. We have muscles for inhaling (inspiratory musculature) and muscles for coughing (expiratory musculature). Weakness in either or both can lead to problems.

The main inspiratory muscle is the diaphragm. When the diaphragm contracts, it actually flattens, creating more space in the rib cage, which causes the lungs to expand. There are also small muscles between the ribs, called intercostal muscles, which aid this process by lifting or separating the ribs. If your inspiratory muscles are weak, the lungs may not fully expand with each breath. This problem can be increased by scoliosis, a common problem among polio survivors. Scoliosis, or curvature of the spine, changes the positions of the ribs and decreases their motion such that the actual size, and therefore volume of the rib cage is diminished. Scoliosis alone can cause respiratory problems, even if the inspiratory musculature is undamaged.

So one source of respiratory problems is not getting enough air in. Another source is not being able to exhale with force, or cough. Under normal circumstances, exhalation is passive. In other words, it does not require muscles. However, if there is anything blocking or irritating the airways, you need to cough to expel it. Coughing requires strong abdominal muscles. If you place your fingers on your belly and cough, you can feel these muscles working. A strong cough is crucial for keeping your lungs clear and healthy.

In the article Pulmonary Dysfunction and its Management in Post-Polio Patients, Drs. Bach and Tilton discuss the fact that many respiratory problems are missed because the symptoms do not seem respiratory in nature. Common symptoms are fatigue, headaches, anxiety, depression and nightmares. It is easy to attribute these symptoms to other causes. It is important to note that shortness of breath or difficulty breathing are usually NOT symptoms.

If you have any concerns about the health of your lungs, I recommend you talk to your doctor or perhaps see a pulmonologist. I also recommend you take a copy of the Bach and Tilton article to your doctor. The article contains recommendations for evaluating and treating polio-survivors. The article is available on-line at the Lincolnshire Post-Polio Library at The full reference for the article is Pulmonary Dysfunction and its Management in Post-Polio Patients; Bach, JR Tilton, Margaret; NeuroRehabilitation 8 (1997)139-153.

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