Neuromuscular respiratory failure and airway clearance — branching viva

Opening — framing the problem

The examiner begins: a 13-year-old boy with Duchenne muscular dystrophy, now a full-time wheelchair user, has morning headaches, daytime sleepiness and three chest infections this winter with a weak cough. How do you frame his respiratory problem? [1] [2]

I would frame it as the two-part respiratory failure of neuromuscular disease. Weak inspiratory muscles cause hypoventilation that appears first in sleep, which explains the morning headaches and daytime sleepiness, and weak expiratory and bulbar muscles cause an ineffective cough with secretion retention, which explains the recurrent chest infections. His lungs are structurally normal, so I would treat the pump and the cough as two separate problems. [1] [6]