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Exertional dyspnoea is commonly an early feature in respiratory disease; however, neurological disease may limit mobility and, as a consequence, preclude this symptom. Diagnosis of respiratory dysfunction resulting from neurological disease may therefore require a higher index of clinical suspicion or the application of specific tests; this exercise is worthwhile if it allows advance detection and discussion and (where appropriate) treatment, of impending overt respiratory dysfunction. Specific symptoms and appropriate tests will be discussed in the text and have also been reviewed in detail elsewhere.1 However, it should be recalled that, at the most basic level, the function of the respiratory muscle pump is to produce inspiratory airflow, which is related to the ability to generate a subatmospheric pressure within the thorax. Thus, although access to detailed investigation of respiratory muscle is not universal, we encourage measurement of both the lying and standing vital capacity2 and static mouth/nasal pressures,3 4 which can be done either in the neurological clinic or in any standard lung function laboratory.
This review deals with acute neuromuscular respiratory disease (including those aspects of respiratory muscle function relevant to intensive care), chronic neuromuscular respiratory disease, sleep related disorders, respiratory consequences of neurological disease, and finally with neurological features of respiratory disease.
Acute neuromuscular respiratory disease
The presentation of acute ventilatory failure due to neurological disease may be genuinely acute or may simply result from any of the causes of chronic respiratory neuromuscular dysfunction, which are discussed below, passing undiagnosed. Patients who present with acute ventilatory failure and no diagnosis usually receive treatment in the form of mechanical ventilation before a diagnosis is reached. The cause may be disease of the nerves, the neuromuscular junction, or muscle5; however, most data relating to the assessment of such patients have been obtained from the study of patients with …