For most walkers breathing is normal, though one study has suggested that there may be a small reduction of breathing ability over time. If chest infections do occur then there should be a careful assessment in clinic of a person’s ability to cough effectively and an exploration of whether they have any symptoms of ‘insufficient breathing’ (poor sleep quality, headaches, and daytime sleepiness). Regular breathing tests (spirometry) should be considered for those that are showing signs of difficulties. However, proactive management of breathing problems is not needed unless the adult or family raises concerns.

Medications used to open the airways (nebulised bronchodilators) should be available if there is high suspicion of asthma or if a clear improvement in breathing is seen after it has been given. Medications to reduce salivary secretions (such as glycopyrrolate) should be used carefully and, with medical guidance, the dose changed as needed. This is to avoid the possibility of the secretions drying out too much, which makes them harder to remove. Long term daily use of medications to breakdown secretions (Pulmozyme® or hyptertonic saline) is not recommended. Antibiotic use during illness should be discussed on an individual basis with the medical team.