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Coughing and ms: Multiple Sclerosis and Breathing Problems

Multiple Sclerosis and Breathing Problems

Respiratory problems can occur in advanced multiple sclerosis (MS). Generally, mild dyspnea (shortness of breath) during strenuous activity is more common in MS than severe respiratory impairment or difficulty breathing while at rest. But even mild breathing impairment can make you less energetic and may interfere with your ability to exercise or engage in taxing tasks.

It is important that you are aware of this potential effect of MS and that you discuss any concerns about your breathing with your doctor.

Verywell / Cindy Chung


Mild respiratory weakness can manifest with shallow breathing, which can be fast or slow. You may not notice this at first, as you might just consider it the way you normally breathe. Regardless, shallow breathing can make you feel run down.

Even fairly mild breathing problems can contribute to your MS-related fatigue and may make you feel that you aren’t well rested, even after a full night’s sleep.

Some other common symptoms of mild respiratory impairment include:

  • Shortness of breath; feeling that you don’t have enough air
  • Hiccups
  • Cough
  • Frequent sighing

Your impaired respiration can contribute to a feeling of discomfort when you lie on your back, prompting you to sit up or change position so you can breathe a little easier.

If your MS begins to have a more substantial effect on your respiratory muscles, you can experience other symptoms, including:

  • Feeling that you are trying to breathe with a blanket over your head
  • Feeling as if you have a heavy weight on your chest
  • Being unable to take a deep breath


In general, MS-related breathing difficulties do not usually become life-threatening, but you can experience serious complications. For example, the feeling that you can’t get enough air can lead to panic attacks and severe anxiety. 

In rare instances, respiration may become profoundly impaired, requiring assistance such as supplemental oxygen or ventilation support.


The severity of breathing problems in MS is closely related to that of the disease; the more advanced your MS, the more likely you are to have related breathing issues (and for them to be significant).

Breathing can be impaired by several factors in MS, including:

  • Muscle weakness: Motor weakness can affect any of your muscles when you have MS. The muscles that control breathing are not commonly affected by MS, but when these muscles are weak, it can take more effort to breathe deeply, especially when you are lying down on your back.
  • Medications: Some prescription medications used for MS-related pain or spasticity (muscle tightness or stiffness) can affect your breathing, making it slower and shallower. These include muscle relaxants, tranquilizers, and opioid-based pain medications.
  • Aspiration pneumonia: MS-related swallowing difficulties or inability to clear mucus from your nose or throat may lead to aspiration pneumonia, which can occur when liquid, mucus, and/or food particles enter the lungs and they become infected. It can take a while to recover from aspiration pneumonia, and breathing is often difficult if you have this condition.

With MS or other neuromuscular diseases, the compounded effects of pneumonia and respiratory impairment (even if you hadn’t noticed it before) can make breathing a major challenge.


There are several tests that can help identify respiratory problems in MS. Your doctor will measure your respiratory rate to determine whether your breathing rate is fast, slow, or normal. Rapid breathing and slow breathing can both occur as a result of MS-induced respiratory problems, and both are not healthy.

There are a number of pulmonary function tests that assess the strength of the muscles you use to breathe. 

Spirometry is one of the simplest and fastest pulmonary function tests, and it measures the amount of air you can breathe in and out. For example, your forced vital capacity is the amount of air you can force out of your lungs with a maximal breath, and this volume is dependent on the health of your lungs and the muscles that control your breathing.

If there is any concern about an infection in your lungs or changes in the structure of your lungs, you may need a chest X-ray or a chest computerized tomography (CT) scan to help your doctors visualize your lungs and the other structures in your chest.


Be sure to talk with your doctor or physical therapist if you experience any symptoms of respiratory impairment. Prevention and/or treatment strategies may be recommended to you.


There are several treatment strategies that can help prevent respiratory problems and maximize your breathing if you have mild respiratory problems. 

  • Minimize your risk of getting a respiratory infection: Avoid people when they have an infection, wash your hands, get your flu shot, and get enough rest. If you start feeling sick or if you develop a cough, contact your doctor right away.
  • Eat softer foods and sit up while you eat to help prevent aspiration pneumonia. Likewise, avoid laughing hard or talking with your mouth full.
  • Respiratory therapy may include breathing exercises to improve overall respiratory function. If you do deep breathing exercises while your MS is mild, you may build lung strength, which can help prevent respiratory complications during later MS stages.

Keep in mind that your MS may remain mild and you may never advance to more severe MS or experience respiratory problems. But it is hard to predict your disease course, so taking precautions early on is better for your overall health.


If you develop severe respiratory impairment, you may need interventional treatment:

  • Nasal oxygen, especially during sleep, is usually used for people who have lung disease. However, if your breathing is affected by your MS, your doctor may consider this option for you.
  • Respiratory support with a non-invasive ventilator or invasive mechanical ventilation is used for managing serious breathing impairment. While not typically needed in MS, these assistive devices may be necessary if you can’t breathe adequately on your own. Your medical team may need to begin respiratory assistance to avoid a sudden or life-threatening emergency.

A Word From Verywell

Weak breathing compounded with overall reduced physical mobility and the risk of infections can predispose you to a prolonged illness from which it may be difficult to recover. Because of this, you need to be vigilant in terms of prevention of respiratory infections, maintaining regular exercise, and getting any breathing problems evaluated. While breathing problems are not common in MS, the potential for them is worth your attention.

Swallowing Problems | National Multiple Sclerosis Society


Dysphagia, or difficulty in swallowing, can occur in people with MS. While more frequent in advanced disease, it can occur at any time. Both chewing and swallowing require a number of muscles in the mouth and throat to work in a coordinated way. In MS, the nerves that control these muscles can become damaged causing weakness and incoordination that can provoke swallowing problems. In addition, numbness of the mouth and throat can occur that can make chewing and swallowing difficult. MS may affect swallowing in a number of ways by causing difficulty managing solids or liquids, frequent throat clearing during eating or drinking, a feeling that food is stuck in the throat, or coughing or a choking sensation when eating or drinking.

Sometimes medications prescribed for other symptoms or conditions can cause dryness of the mouth which can make swallowing – particularly dry or crumbly foods difficult.

Swallowing problems are important to recognize early. When swallowing problems persist or worsen there is a risk of aspiration – which means food or fluids getting into the lungs – and this is a serious problem.

Treating swallowing problems

Dysphagia is initially diagnosed by a careful history and neurologic examination of the tongue and swallowing muscles. A special imaging procedure called a modified barium swallow can be used to evaluate a person’s ability to chew and swallow solids and liquids. In this test, the person eats and drinks a small quantity of barium, which makes the structures of the mouth, throat, and esophagus visible on x-ray. The movement of these structures is recorded on videotape by a videofluoroscope as the person eats or drinks foods of varying consistencies — thin liquid, thick liquid and solid. The precise location and manner of a swallowing defect can then be identified, and treatment prescribed.

A speech/language pathologist is the professional who diagnoses and treats dysphagia. Treatment typically consists of strategies for safer eating and swallowing, dietary changes, exercises or stimulation designed to improve swallowing.  

Signs and Symptoms – msBucket

Ageusia is the loss of the sense of taste and is a rare symptom of
multiple sclerosis (MS).Aphasia
Aphasia is difficulty understanding the speech of other people
and/or expressing oneself verbally. While people with multiple
sclerosis (MS) often have trouble finding words or communicating,
this is more often dysphasia, a symptom of MS which is not as
severe as aphasia.

Ataxia is a lack of coordination and unsteadiness. It is a common
symptom of multiple sclerosis (MS).

Ataxia (Sensory)
Sensory ataxia is a lack of coordination caused by numbness in the
feet. It can be a symptom of multiple sclerosis (MS).

Bladder Dysfunction
Bladder dysfunction is one of the most common symptoms of
multiple sclerosis (MS). Problems with urination, whether it be
urinary hesitancy, frequency or incontinence, should never be

(BPPV) Benign Paroxysmal Positioning Vertigo

About 20% of people with multiple sclerosis (MS) experience vertigo
at some point. While this can be caused by an MS lesion, it is
actually more likely to be caused by benign paroxysmal positioning
vertigo (BPPV), a condition which is largely unrelated to MS and can
be treated without medications.

Constipation is a very common symptom of multiple sclerosis (MS),
with up to 75% of people with MS experiencing it at some point. It is
caused by many different things, including MS lesions and certain

Cognitive Dysfunction
Cognitive dysfunction is one of the most common symptoms of
multiple sclerosis (MS), yet one of the most overlooked. Problems
with short-term memory, attention difficulties and word-finding
problems are all part of MS-related cognitive dysfunction.

Depression is a common symptom of multiple sclerosis (MS). It is
often confusing to diagnose, as it shares many of the same
symptoms with MS itself. However, if you have MS and are
experiencing sadness or loss of interest in things, you need to seek
help. A doctor can determine your level of depression and the
appropriate treatment.

Devic’s Disease (Nueromyelitis)
Devic’s disease is an inflammatory disease of the central nervous
system in which there are episodes of inflammation and damage to
the myelin (fatty, protective covering of nerves) that almost
exclusively affect the optic (eye) nerves and spinal cord. It usually
causes temporary blindness, occasionally permanent, in one or
both eyes. It can also lead to varying degrees of weakness or
paralysis in the legs or arms, painful spasms, loss of sensation, and
bladder or bowel dysfunction from spinal cord damage.

Diplopia or Double Vision
Diplopia, or “double vision” is a common symptom of multiple
sclerosis (MS).

Problems swallowing as a Symptom of Multiple Sclerosis
Problems with swallowing, called dysphagia, is a common symptom of
multiple sclerosis (MS). It includes choking, coughing, gagging and
problems with the voice.

Dysarthria is a fairly common symptom of multiple sclerosis (MS). It
is a speech disorder in which the pronunciation is unclear, but the
meaning of what is said is normal.

Dysdiadochokinesia is the inability to perform rapid, alternating
movements. It is a common sign of multiple sclerosis (MS).

Dysesthesia is a condition in which a light touch is perceived as
painful or unpleasant. It is a common sensory symptom of multiple
sclerosis (MS).

Dysmetria is the inability to coordinate movements, characterized
by “overshooting” or “undershooting” the intended position of the
hand, arm or leg. It is a common symptom of multiple sclerosis

Dystonia is impaired or disordered muscle tone, which is
characterized by slow movement or an extended, sustained spasm
in a group of muscles. It can be a symptom of multiple sclerosis

Dysphonia is an impairment of the voice and is a fairly common
symptom of multiple sclerosis (MS).

Dysphasia is difficulty understanding or using language. It can be
a symptom of multiple sclerosis (MS).

Erectile Dysfunction
Erectile dysfunction is a very common symptom of multiple
sclerosis (MS), experienced by up to 85% of men with MS.

Facial Pain- Trigeminal neuralgia
Trigeminal neuralgia, also known as tic doloureux, is perhaps the
most painful symptom of multiple sclerosis (MS). Experienced by
4% of people with MS, it is a sharp, severe pain in the lower part of
the face, often brought on by chewing or touch.

Fatigue is the most common symptom of multiple sclerosis – it is
estimated that between 85 and 95 percent of people with MS
experience MS-related fatigue at some point. At its worst, it is the
result of many factors combined, including the MS disease process
itself, as well as side effects from medications, exacerbations of
other symptoms, and lack of exercise and good nutrition.

Foot Drop
Foot drop is when the front of the foot falls behind and tends to
drag on the ground.

Heat Intolerance
If you have multiple sclerosis (MS), there is a good chance that you
have felt negative effects from the heat in the form of increased
symptoms from pseudoexacerbations. These symptoms can range
from annoying to debilitating, but usually disappear quickly once
you cool down.

People with multiple sclerosis (MS) are more likely to experience
migraines or cluster headaches than those in the general
population. There are several different causes for headaches in
people with MS, including: medication side effects, lesions, optic
neuritis and depression.

Hemiparesis is weakness or partial paralysis on one side of the
body. It can be a symptom of multiple sclerosis (MS).

(IEED) Involuntary emotional expression disorder
Also known as pseudobulbar affect, is a symptom that affects
approximately 10% of people with multiple sclerosis (MS). IEED is
characterized by outbursts of crying or laughter, but without
corresponding emotions behind these outbursts. Learn more about
IEED to make sure that you are receiving the correct diagnosis and

Loss of Proprioception
Proprioception is the sense of one’s body in relation to itself and the
world. Multiple sclerosis (MS) often affects a person’s sense of
balance by slowing down transmission of signals that regulate
proprioception. This is known as Romberg’s sign.

“MS Hug”
“Hug” or Girdle-Band Sensation feeling of tightness as if a belt was
being tightened around your body parts. The “MS hug” or girdleband
sensation is a symptom of multiple sclerosis, resulting in a
painful or tingling feeling around the torso or in one area on the
abdomen or chest.

Numbness and Tingling (Parasthesia)
Numbness and tingling is a very common symptom of multiple
sclerosis (MS), known as parasthesia. This type of symptom is
described as tingling, burning, prickling, itching, numbness or the
feeling of “pins-and-needles.”

Nocturia is the need to urinate frequently at night.

Nystagmus means involuntary, rapid repetitive movements of the

Neuralgia is sharp pain in a nerve or along a nerve pathway. It can
be a symptom of multiple sclerosis (MS).

Optic Neuritis
Optic neuritis is a fairly common symptom of multiple sclerosis
(MS), affecting up to half of people with MS. Also, 50 to 60 percent
of people experiencing optic neuritis will go on to develop MS in the
next 10 years. The main symptoms of optic neuritis are: pain when
moving the eyes, absence of color in viewed objects and blurring or
blank spots in the visual field.

Paresis is muscle weakness or incomplete paralysis. It is a common
symptom of multiple sclerosis (MS).

Parasthesia describes an abnormal sensation that is not typically

Pain is now recognized as one of the most common symptoms of
multiple sclerosis (MS). There are several causes, including the
disease process itself or as a result of other symptoms. Some types
of MS-related pain are sudden and fleeting, while others are more

Many of us with multiple sclerosis (MS) have experienced the
phenomenon of paroxysmal symptoms — those that come on
suddenly, bother us for a short time (seconds or minutes), and then
disappear as suddenly as they came. Whether it is an episode of
double vision or a prickly feeling on my face, these moments
usually lead me to wonder a number of things. Is this a relapse?
How bad is this going to get? Does this mean my MS is progressing?

Pupillary Defect (APD)
People with MS occasionally experience a phenomenon known as
afferent pupillary defect (APD), which is when one pupil dilates
when it would normally constrict. This is due to inflammation of the
optic nerve, or optic neuritis.

Respiratory Problems
Many people with multiple sclerosis (MS) have low respiratory
function, even though they might not have noticed it or associated
it with MS. Coughing, frequent sighing and shortness of breath can
all be part of MS.

Restless Legs Syndrome
Research shows that people with multiple sclerosis (MS) are about
five times more likely to have restless legs syndrome (RLS)
than people in the general population. Restless legs syndrome
symptoms are very different from other symptoms of MS, such as
spasticity and parasthesia (numbness and tingling).

Epilepsy and seizures as a symptom of multiple sclerosis (MS) are
rare, only occurring in 2 to 3 percent of people with MS. However,
this is still higher than in the general population. These seizures in
people with MS tend to be either tonic-clonic or partial seizures,
and can usually be treated very successfully with medications.

Spasticity and Stiffness
Spasticity is a common symptom of multiple sclerosis (MS). Much
spasticity is experienced as slight to moderate difficulty moving, as
muscles don’t relax as quickly or easily as they should. However,
some spasticity is more dramatic and can cause long-term problems
and contribute to lack of mobility.

Spasms (Flexor)
Flexor spasms are a form of spasticity in which the legs or other
limbs are pulled upward into a clenched position.

Spasms (Extensor)
Extensor spasms are a form of spasticity in which the legs suddenly
straighten into a stiff, extended position. This is a fairly common
symptom of multiple sclerosis (MS).

Scanning Speech
Scanning speech is a speech disorder in which syllables of words
are separated by pauses. It can be a symptom of multiple sclerosis

A scotoma is an area of reduced vision or blindness. It is a common
symptom of multiple sclerosis (MS), indicating the presence of optic

Tremor is a very common symptom of multiple sclerosis (MS). It can
happen when a person is trying to do something with their hands or
when standing or sitting, and severity can range from barely
noticeable to significantly interfering with daily tasks. Learn more
about tremor as a symptom of MS.
Trigeminal Neuralgia
Trigeminal neuralgia affects the trigeminal nerve, one of the largest
nerves in the head. The trigeminal nerve sends impulses of touch, pain,
pressure, and temperature to the brain from the face, jaw, gums,
forehead, and around the eyes

Vertigo is a fairly common symptom of MS, occurring in about 20%
of people at some point. The good news it that it is not a permanent
symptom, and may not even indicate a new lesion or inflammation,
as vertigo can have non-MS causes.

MS Association
Mayo Clinic

Cough efficacy is related to the disability status in patients with multiple sclerosis


Cough is an important defense mechanism, whose main function is to remove mucus and/or foreign bodies from the airways. In patients with multiple sclerosis (MS), respiratory muscle function may be affected and cough may be impaired.


Respiratory muscle strength and voluntary cough efficacy were determined in MS patients and controls, and the relationship between cough efficacy and patients’ degree of disability was investigated.


We recruited 27 MS patients (age: 41 +/- 11 years; 18 females) with mild-to-moderate disability, Expanded Disability Status Scale (EDSS) score range: 1-7, and 20 healthy controls (age: 37 +/- 11 years; 12 females). The maximal inspiratory (PIMAX) and expiratory (PEMAX) pressures, maximal whistle mouth pressures (PMOW), cough peak flows (CPF), cough expiratory volumes (CEV) and cough gastric pressures (PGA) were measured in all subjects.


In MS patients, the EDSS score was significantly related to CPF, PEMAX, PMOW, cough PGA, PIMAX and CEV (p < 0.01, each correlation). The receiver-operating characteristic curve showed that an EDSS score > or =5.5 was consistent with impaired cough (CPF < or =5.6 l/s), with a sensitivity of 0. 85 and a specificity of 0.95 (area under curve 0.90, p < 0.001). CPF was related to and predicted by PEMAX, PMOW, cough PGA and PIMAX in MS patients (p < 0.01 each correlation), but not in controls.


MS can affect voluntary cough efficacy and respiratory muscle strength, which are inversely related to the patients’ degree of disability. In addition, this study shows that CPF is a measure of clinical relevance in MS patients.

Swallowing | Multiple Sclerosis Society UK

Different techniques help with different problems, which is why it is important to have the advice of a health professional to help find what suits you. They may suggest some of the following techniques for you, your family or carers:

Good posture

Keep a good, upright posture when eating and drinking. A physiotherapist can help with this. Stay upright for at least 30 minutes after a meal. You may also want to read MS Essentials Factsheet: Posture and movement 1 – an introduction and MS Essentials Factsheet: Posture and movement 2 – moving well with MS.

Relaxed atmosphere

Eat in a relaxed atmosphere. Swallowing can be easier if you’re relaxed. Being relaxed might help you concentrate on your swallowing, or help your swallowing muscles work as best as they can. Some people find it best to eat in a quiet atmosphere, without radio, TV or conversation for distraction.

Eat slowly

Don’t rush a meal. If the swallowing process is not in perfect working order, allowing it the time to deal with each swallow in turn can be helpful.

Chew well

Chewing well helps get the food ready for swallowing, mixing it well with your saliva.

Alternate liquid with solid

For some people, swallowing problems mean that food gets stuck, or travels only very slowly towards the stomach.

Drinking between mouthfuls can help keep the food moist and wash it down.

Avoid speaking whilst eating

The two different processes can interfere with each other and could increase the chance of choking.

Adapt the food you choose

There are ways of adapting the food you like to suit you better. If very thin liquids are likely to go down the wrong way, thickeners could make them easier to swallow. You might try eating softened foods, or moistening dry foods, perhaps with a sauce. Speech and language therapists can suggest ways to get the right consistency for you.

Get nutritional advice

To make sure you get the nutrition you need, a dietitian can help you plan what you eat. For example, if you find it uncomfortable to eat larger meals, then smaller, more frequent meals and milky drinks might help you get enough calories.

Nutritional supplements are helpful for some people.

> Find out more about diet and MS

3 Characteristics and Management of Major Symptoms | Multiple Sclerosis: Current Status and Strategies for the Future

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“Leaving the House is The Hardest Part Now”

Mimi Grabovenko is all right despite a persistent, painful cough. It’s the tendency to panic in public places now—not her multiple sclerosis—that keeps her close to home. 

Mimi Grabovenko has MS and survived COVID-19. Despite a persistent, lingering cough her health is all right but she has developed a new, related symptom—panic attacks.

Anamaria (Mimi) Grabovenko, who has multiple sclerosis (an autoimmune disease that affects the central nervous system), first came down with the symptoms of COVID-19 on March 31 and tested positive for the virus in early April. The Long Island mother battled fevers, shortness of breath, an incessant cough, vomiting, and diarrhea for a few weeks while isolating from her husband and daughter in the family’s guest house.  

She also experienced the loss of taste and smell, a rash from her chest to her knees, and sores on the tips of her toes. After three additional COVID-19 tests, she finally tested negative for the virus on May 27. She moved back into the house to be with her family, and neither her husband nor her daughter got the virus.

But she still has a lingering cough, she rarely goes out, preferring to get her groceries delivered, and she’s only recently been strong enough to start back on her MS medication. Practical Pain Management first reported Mimi’s storyin the spring of 2020.  Here’s an update on what her life is like now.

Not Sick Enough for the Hospital 

Mimi, who was diagnosed 17 years ago with relapsing remitting multiple sclerosis, had been running two preschools near her home for decades. Both schools closed due to the pandemic on March 13, 2020. Two weeks later, Mimi first experienced fatigue, fever, and coughing. When she was diagnosed with COVID-19, she was not sick enough to be hospitalized, but her doctors called to check in every day to see how she was doing.

During the next several weeks, she would be fever-free for a few days but then the fever would return. The cough was ongoing. Her doctor recommended that she stop her treatments for MS because her system just wasn’t strong enough.

Having MS does not increase the risk of dying from COVID-19, current evidence suggests. But people with MS may be more susceptible to having a severe case of COVID-19 if they do get the virus.1

Certain MS medications may increase the likelihood of developing complications from a COVID-19 infection but these risks should be balanced with the risks of delaying or stopping treatment, according to the National Multiple Sclerosis Society.2

In general, individuals with MS who currently take disease modifying therapies (DMTs) may continue with their treatment but those who test positive for COVID-19 or develop symptoms of the virus should consult with their health care provider to find out the best course of action.

Besides testing positive for the virus for several weeks, Mimi didn’t develop any detectable levels of antibodies to COVID-19.

“My doctor thinks the reason I didn’t develop antibodies is because of the chemo medication I am on to treat my MS,” Mimi says. “Yet another person I know who had COVID and is on the same medication did develop antibodies, so it’s hard to tell.”

Shaking and Tingling: MS or COVID-19?

Meanwhile, back in the spring of 2020, because she hadn’t received her MS medication for two months, she began to experience MS symptoms.  “My classic symptom is that I start having trouble closing my left hand and I can’t grab things,” Mimi recalls. “Usually, it starts in my pinkie finger. It becomes very easy for me to drop things. But my doctor recommended that I not get my treatment at that point.”  

Her symptoms did not abate and it was sometimes hard to tell what was from MS and what was from the virus. “I would get the shakes and have the tingling in my fingertips during these two months,” she recalls. “But I was getting the shakes from COVID, too, so it was hard to tell which was what. Personally, I felt that it was due to the MS.  I’ve had MS for a long time, and I know my body so well.”

Mimi normally gets two infusions of her MS medication (they are spaced two weeks apart) every five or six months.  After not getting her medication since October 2019, She was finally able to get two infusions of her MS medication two weeks apart, receiving one on July 9, 2020 and one on July 23, 2020. and says she is feeling better after the second dose. “I totally feel the difference,” she says. “I can feel my fingers again.”

Panick Attacks, A New Symptom  

But while Mimi’s MS symptoms have improved now that she can take her medication again, she still doesn’t feel completely recovered from COVID-19. Her persistent cough is painful and when she takes a deep breath, it hurts. “And I still can’t sleep on my back,” she says. “I still have this funny feeling in my esophagus when I try. So I sleep on my stomach now.”

She bought a pulse oximeter while she was ill, and says her oxygen level is usually between 95 and 97. When she is having a coughing fit, it can go as low as 90.

Mimi’s doctor does not feel that she faces long-lasting effects from COVID-19, although he does want her to see a cardiologist at some point for an evaluation. Physical symptoms aside, Mimi says that having COVID-19 has left her psychologically traumatized.  She has become hesitant to go out. “I went to the mall recently and began having a panic attack because the person next to me was too close,” she recalls. “Luckily, my daughter was there and pointed out to the woman that she should not be that close.”

Mimi sold the building that housed one of her preschools, and that school closed permanently. The other preschool, housed in a church, is closed this year but may reopen next year. If so, Mimi may go back to running it again. “But right now, the health risks for me are just too high,” she says.

Still, she ventures out more and more. She’s even been to the supermarket. But if she gets there and the line is out the door, she won’t stay to do her shopping as she doesn’t want to be around crowds. Nearly seven months after her diagnosis, she is still having a hard time sleeping, waking up at 3 am and not being able to fall back to sleep until 5am.

But Mimi remains determined to move forward. “I don’t believe that my body could go through this again,” she says. “I can’t just sit still. I definitely want to take on some new projects but I need to figure it out. I just know that I can’t handle a lot of stress right now.”


Updated on: 10/02/20

How Two Immunocompromised Sisters are Fighting the Coronavirus Quarantine

90,000 Memo for the population about the new type of coronavirus 2019-nCoV

January 30, 2020

The possibility of importing a new type of 2019-nCoV coronavirus discovered in China into Russia cannot be completely ruled out. However, the likelihood of its spread throughout the country is assessed as low, the press service of Rospotrebnadzor told TASS.

According to Rospotrebnadzor, the main danger of the new coronavirus is that it causes a fatal disease for humans. ” The virus has spread beyond China to South Korea, Japan and Thailand.Beijing has officially confirmed that 2019-nCoV is transmitted from person to person, in connection with which it becomes necessary to carry out preventive and anti-epidemic measures when identifying and hospitalizing patients with suspected disease caused by a new type of coronavirus 2019-nCoV (hospitalization in boxes with any severity indication of location in China, work in masks, gloves, change of protective clothing when moving to patients with other diseases).

Clinical manifestations of the disease.

Coronaviruses are a family of more than 30 viruses, divided into two subfamilies. They were first allocated in 1965. They affect people, domestic animals, birds, pigs, cattle.

Currently, only 6 coronaviruses are known to infect humans. Four of these tend to cause symptoms of the common cold. The other two, Severe Acute Respiratory Syndrome (SARS) coronavirus and Middle East Respiratory Syndrome (MERS) coronavirus, cause serious respiratory illness that can be fatal.

Coronavirus is capable of provoking damage to the respiratory system, gastrointestinal tract, and nervous system.

Experts refer to the main symptoms of the new coronavirus as fever, fatigue and cough with a little phlegm. In the future, patients may experience shortness of breath. According to laboratory tests, in patients in the early stages, the level of leukocytes was normal or low, and the level of lymphocytes decreased, some had an increased amount of liver and muscle enzymes.

At an early stage of the disease, more than 90% of patients had fever, about 80% had a dry cough, more than 20% had chest tightness, about 20% of patients had shortness of breath, about 15% had dyspnea, about 80% had normal or a decreased white blood cell count, and in all patients, chest radiographs showed pneumonia.

When visiting diseased territories or caring for the sick, to protect the respiratory system, use only industrial medical masks with a high efficiency of bactericidal filtration to protect against biological fluids. Masks should fit snugly to the face, exclude lateral air leakage and have a strip of obturation.

When leaving the patient at home, temporary or barrier (until recovery) isolation of the sick person within the apartment is recommended.

Persons living in hotels and hostels with clinical manifestations of ARI are isolated until examined by a doctor, if necessary, hospitalized.

Places of temporary isolation of the sick must be provided with the necessary means to limit the spread of the virus from the sick:

alcohol-containing antiseptics for maintaining hand hygiene;

disposable handkerchiefs for removing nasal mucus;

polyethylene bags for disposal of used items;

factory-made medical masks;

technical means and equipment for wet cleaning of premises;

detergents and disinfectants, including air disinfection agents.

Case history: face to face with a fatal illness

Residents of the city shared their experience of fighting the coronavirus with MC.

“I was 100% sure that it was a common cold,” 46-year-old Anna Zakharova, a resident of Stroiteley Street, says into my phone. – It’s hard to say where I could get infected, in public transport or in a store … But I explained my discomfort by the fact that on May 9 we were very cold and the whole family caught a cold. It all started with a sharp rise in temperature to 38.5.I asked for a day at work to lie down. I called the doctor at home. They prescribed me antiviral and antipyretic drugs and said that they would come to take a test. Almost immediately, a cough appeared, so cough medications were prescribed. The local doctor visited me on Wednesday and a throat swab was done two days later. I learned the test result only ten days later, when I was already feeling well. The course of treatment has passed, I was ready to go to work, but before I found out the test result, the temperature was again up to 37.5, and the test turned out to be positive, – said Shuyanka.Anna called her cough strange – neither dry nor wet, and besides fever and cough, aches and fever were observed at high temperatures. Doctors called her every day, inquired about her well-being. After the test was positive, Anna’s 14-year-old son also had a swab. The result is not yet known. For prevention, mom and son drank antiviral drugs in advance for five days. SES employees, having called Anna Zakharova, offered to treat the apartment with antimicrobial reagents.“I refused, referring to the fact that I simply do not have the strength and health to wash everything afterwards, and I’d rather wash the apartment myself with bleach, in the end, they processed only the entrance,” she explained. Anna and her son are in self-isolation. “If it weren’t for the test result, I would have already gone to work. I feel good, there is no weakness or other symptoms. I am engaged in household chores, which my hands did not reach, ”- summed up our conversation Shuyanka.

Another interlocutor of mine, Natalya Fedorovna, ended up in the infectious diseases department of the Shuya Central District Hospital on May 13.A woman over 60, lives alone. “When the self-isolation regime was introduced,” says Natalya, “I was working. I felt unwell in early May. Weakness literally knocked down, even doubted that I could go to work. And the temperature rose to 37 “kopecks”. Still, on May 10, I went to the clinic, where the thermometer showed a temperature of 37.5. I was prescribed antibiotics and antiviral drugs. I didn’t even have the strength to eat, although my stomach ached after the pills. Then the temperature rose to 38 degrees.The doctors called me all the time, they were interested in my well-being ”…

Worried about Natalya’s condition, her husband arrived from Ivanovo and called an ambulance. The woman was hospitalized on May 13. After computed tomography she was diagnosed with bilateral pneumonia of the lungs and tested positive for Covid-19. Of all the symptoms, we repeat, there was only a high fever.

– Two patients who were with me in the ward had a severe dry cough. Subsequently, I also had a cough.I treated him for 5-6 days. And they discharged me home in ten days. Since then I have already passed the tests twice. In general, recovery is not a quick matter. I try not to lie down, I do my usual household chores. During home isolation, my husband brought me food, put it at the door, knocked and left. And I talked to him from the balcony, – said Natalya.

– What conclusion have I made? You need to strengthen the immune system, you need to fully rest in order to gain strength, you need to go to your favorite job and be useful to people.I also consider it my duty to thank the Shuya doctors, because now I know firsthand how hard it is for all of them today, and how selflessly they are fighting for each patient, ” Natalya Fedorovna summed up.

From 9 June 2020
Interviewed by Tamara OGNEVA

indications and contraindications, composition and dosage – Pharmacy Mos

Special instructions

Patients with impaired renal function: there is no experience of safe use of valsartan in patients with CC less than 10 ml / min and in patients on hemodialysis, therefore, Valsartan Medisorb should be used with caution in such patients. In patients with CC more than 10 ml / min, dose adjustment is not required.
The simultaneous use of ARA II with drugs containing aliskiren is contraindicated in patients with diabetes mellitus and / or with moderate or severe renal impairment (GFR less than 60 ml / min / 1.73 m2 of body surface area) and is not recommended in other patients.
The simultaneous use of ARA II with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
Liver dysfunction: in patients with mild to moderate hepatic dysfunction without cholestasis, valsartan should be used with caution.Hyperkalemia: when used simultaneously with dietary supplements containing potassium, potassium-sparing diuretics, potassium-containing salt substitutes, or with other drugs that can cause hyperkalemia (for example, with heparin), caution should be exercised and regular monitoring of the potassium content in the blood plasma should be carried out.
Kidney transplantation: There is no data on the safety of valsartan in patients undergoing kidney transplantation.
Deficiency in the body of sodium and / or a decrease in BCC: in patients with a pronounced deficiency in the body of sodium and / or reduced BCC, for example, receiving high doses of diuretics, in rare cases, at the beginning of treatment with the drug, arterial hypotension may occur, accompanied by clinical manifestations.Before starting treatment with the drug, the sodium and / or BCC content in the body should be corrected, including by reducing the dose of the diuretic.
Renal artery stenosis: the use of the drug in a short course in patients with renovascular hypertension, secondary to unilateral stenosis of the renal artery of a single kidney, does not lead to any significant changes in renal hemodynamics, serum creatinine concentration or blood urea nitrogen. However, given that other drugs that affect the RAAS can cause an increase in serum urea and creatinine concentrations in patients with bilateral or unilateral renal artery stenosis, monitoring of these parameters is recommended as a precautionary measure. Primary hyperaldosteronism: the drug is ineffective for the treatment of arterial hypertension in patients with primary hyperaldosteronism, since there is no activation of the RAAS in this category of patients.
Aortic and mitral stenosis: obstructive hypertrophic cardiomyopathy As with other vasodilating agents, care should be taken when taking the drug in patients with aortic and mitral stenosis and obstructive hypertrophic cardiomyopathy.
Pregnancy: ARA II is contraindicated during pregnancy.Patients planning a pregnancy need to choose treatment with alternative drugs that have a proven safety profile when used during pregnancy. If pregnancy is diagnosed during the period of drug treatment, it should be noted as soon as possible and an alternative treatment should be prescribed.
Chronic heart failure / period after myocardial infarction: in patients with CHF or after suffering myocardial infarction, starting treatment with valsartan, there is often a slight decrease in blood pressure, and therefore, it is recommended to control blood pressure at the beginning of therapy. Subject to the recommendations for the dosage regimen, there is usually no need to discontinue the drug due to arterial hypotension. Assessment of the condition of patients with CHF should include an assessment of renal function.
Due to the inhibition of the RAAS, renal dysfunction is possible in some patients. In patients with CHF III-IV functional class according to the NYHA classification, whose renal function depends on the state of the RAAS, treatment with ACE inhibitors and ARA II may be accompanied by oliguria and / or an increase in azotemia and, in rare cases, the development of acute renal failure and / or death.Therefore, in these categories of patients before using valsartan, as well as periodically during drug therapy, it is necessary to assess renal function.
Combination therapy for arterial hypertension:
with arterial hypertension, the drug can be used in monotherapy, as well as simultaneously with other antihypertensive drugs, in particular, with diuretics. Combination therapy in the period after myocardial infarction:
It is possible to use the drug in combination with other drugs used after myocardial infarction, namely: thrombolytics, acetylsalicylic acid as an antiplatelet agent, beta-blockers and HMG-CoA reductase inhibitors (statins). In this category of patients, it is not recommended to use the drug simultaneously with ACE inhibitors. as this combination therapy has no advantages over valsartan monotherapy or an ACE inhibitor in terms of all-cause mortality.
Combination therapy for CHF: for CHF, the drug can be used both in monotherapy and simultaneously with other drugs – diuretics, cardiac glycosides, as well as ACE inhibitors or beta-blockers. In this category of patients, the use of triple combination therapy with ACE inhibitors, beta-blockers and valsartan is not recommended.Angioedema, including Quincke’s edema:
angioedema, including of the larynx and vocal cords, leading to airway obstruction and / or edema of the face, lips, pharynx and / or edema of the tongue, occurred in patients treated with valsartan, some of these patients previously had angioedema in the background taking other drugs, including ACE inhibitors. Taking the drug in the event of the development of angioedema should be immediately canceled, the resumption of the drug intake is prohibited.Double blockade of the RAAS: when treated with drugs that affect the RAAS, especially when combined, a pronounced decrease in blood pressure, syncope, stroke, hyperkalemia and changes in renal function (including acute renal failure) have been reported in sensitive patients. Caution is required when combining ARA II, including valsartan, with other drugs that block RAAS, such as ACE inhibitors or aliskiren. The simultaneous use of ARA II with drugs containing aliskiren is contraindicated in patients with diabetes mellitus and / or with moderate or severe renal impairment (GFR less than 60 ml / min / 1.73 m2 of body surface area) and is not recommended in other patients.The simultaneous use of ARA II with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
Other conditions for stimulation of the RAAS (for a dose of 320 mg): for patients in whom renal function may depend on the activity of the RAAS (for example, patients with severe congenital heart failure), treatment with ACE inhibitors is associated with the manifestation of oliguria and / or progressive azotemia and, in rare cases with acute renal failure and / or death.Since valsartan is an ARA II, it cannot be ruled out that its use may be associated with impaired renal function.
Children and adolescents from 6 to 18 years old with impaired renal function: in patients from 6 to 18 years old with impaired renal function with CC less than 30 ml / min, as well as in patients on hemodialysis, the use of valsartan has not been studied, therefore the use of the drug in this group of patients is not recommended. In patients from 6 to 18 years old with CC more than 30 ml / min, dose adjustment is not required.While taking the drug, you should carefully monitor kidney function and the content of potassium in the blood plasma. In particular, these precautions must be observed when taking valsartan against the background of an elevated temperature or with a reduced BCC, since in this case, impaired renal function may develop.
Liver dysfunction: as for adult patients, the use of the drug is contraindicated for patients from 6 to 18 years old with severe liver dysfunction, biliary cirrhosis and cholestasis.The experience of using valsartan in patients with mild to moderate hepatic dysfunction is limited. Do not exceed a dose of 80 mg in this group of patients.
Influence on the ability to drive vehicles and work with mechanisms: since against the background of drug therapy, such undesirable phenomena as dizziness or fainting may develop, patients taking valsartan should be careful when driving and engaging in potentially hazardous activities.

Clinical Study Cough: BC1036 – Clinical Trials Registry

Inclusion Criteria:

– Male or female aged 18 to 75 years.

– Confirmed diagnosis: persistent cough.

– Leicester Cough Questionnaire score ≤ 17 at baseline.

– FEV ≥ 70% of the norm at screening. See Appendix 4 to the protocol for a formula for calculating the predicted values.

– We are ready to use effective contraceptives during the research. Female subjects that have not been surgically sterilized or postmenopausal (defined as no menses for one year or FSH> 40 mIU / L) will be required to use the two methods throughout the study and for 30 days thereafter. In addition to abstinence, the following contraceptive methods are acceptable: hormonal (for example, oral, injection, transdermal patch, implant, cervical ring), barrier (for example, a condom or diaphragm with a spermicidal agent), or an intrauterine device.If hormonal contraceptives are used, they must be used from 6 weeks before the first dose of the test product. Male subjects must consent to the use of condoms for the duration of the study and 30 days afterwards.

– Willing and able to give informed consent and comply with test assessments and any other legal proceedings.

Exclusion criterion:

– Pregnant or lactating females.

– Major surgery within 30 days prior to the inspection visit.

– Any serious infections within 30 days of the check-up visit.

– Uncontrolled intercurrent illness, including, but not limited to, current or active infection, symptomatic congestive heart failure, unstable angina pectoris, heart failure. arrhythmia, uncontrolled diabetes, kidney or liver disease, or psychiatric illness / social situations that limit adherence to study requirements.

– Known hepatitis B or C, human immunodeficiency virus (HIV) or syphilis seropositivity.

– History of serious adverse allergic reactions to any medications.

– Treatment with another investigational drug within 30 days prior to enrollment.

– Treatment:

– Systemic oral steroids within 7 days prior to randomization at visit 2.

– Theophylline and theophylline-like drugs within 7 days before randomization.

– Opiates or opioids, eg codeine, dextromethorphan, within 7 days prior to randomization.

– ACE inhibitors within one month prior to the check-up visit.

– Depot injection of corticosteroids within 6 weeks of the check-up visit.

– History of a febrile illness in the last 7 days before the examination. visit.

– Subjects with significant sputum production (defined as more than 5 ml (~ one teaspoon) / day on any three days during the screening period).

– Current smokers or past smokers who have smoked for more than 20 packs of years, or have quit smoking ≤ 12 months before the test.

– Any concomitant lung disease such as COPD, recurrent lower respiratory infections. (≥ 2 12 months before screening) and bronchiectasis, in which the cough is suppressed, can lead to sputum retention and infection.

– Any pulmonary abnormality on chest x-ray or computed tomography performed within twelve months prior to enrollment indicates COPD, bronchiectasis, etc.

– Subjects diagnosed with asthma who have had an exacerbation requiring hospitalization 4 weeks prior to examination …

– History of cancer within the previous five years (excluding carcinoma in situ or non-melanoma skin cancer treated with surgical excision).

– Uncontrolled hypertension (systolic blood pressure at rest> 170 mm Hg or diastolic blood pressure at rest> 95 mm Hg).

– Adjusted QT interval> 470 ms for women or> 450 ms for male subjects, calculated using the QTcF correction formula, or grade II or higher ECG blockade at screening.

– Subject known to be sensitive to methylxanthines and related compounds or known to have an allergic reaction or sensitivity to cocoa-based products.