Respiratory disorders in people with developmental disability

Respiratory disorders are one of the most common causes of death in people with intellectual disability across all life stages, due to the high risk of aspiration caused by chronic dysphagia; immobility, deformity (eg scoliosis) or reduced immunity may also contribute to the risk of complications from aspiration. Suspect aspiration in a person with a history of recurrent respiratory infection or cough while eating or drinking.

Inhaled or intranasal foreign bodies can result in persistent respiratory symptoms (eg purulent nasal discharge), atypical presentation (eg behaviour change) and late presentation (eg pneumonia, sepsis). Practitioners should maintain a high index of suspicion in all cases.

For the treatment of aspiration pneumonia and lung abscesses, see Aspiration pneumonia and Lung abscess.

Treat people with asthma as for the general population; see Maintenance management of asthma in children and Maintenance management of asthma in adults and adolescents. Reasonable adjustments may be needed to enable a person with developmental disability to follow their asthma plan and use inhalation devices; involve carers in asthma education to support the correct use of inhalation devices.

Refer people with chronic severe respiratory disease (including chronic obstructive pulmonary disease [COPD]) to a respiratory physician; see also Stable chronic obstructive pulmonary disease (COPD).

Sleep-disordered breathing, including apnoea, is common and underdiagnosed in adults and children with developmental disability. Obstructive sleep apnoea (OSA) is more common in obese patients and almost universal in people with Down syndrome by adulthood.

As in the general population, ask about snoring, apnoea, daytime drowsiness and behaviour or mood changes. For clinical features in children and in adults, see Clinical features of obstructive sleep apnoea in children and Symptoms suggestive of obstructive sleep apnoea and common comorbidities.

Refer people with suspected OSA to a sleep physician for diagnosis and management. Continuous positive airway pressure (CPAP) is the most effective therapy for OSA (see Obstructive sleep apnoea in children and Obstructive sleep apnoea in adults). However, CPAP may not be tolerated and a trial of different devices or masks may be needed—train people with developmental disability and their carers or support workers to use CPAP devices.