In the 15 years since Nicole Miller sustained a spinal cord injury at the C1-5 levels, she has battled respiratory distress and pneumonia almost every year. Miller, a 35-year-old quad who works as the outpatient clinical care counselor at Craig Hospital, has dealt with collapsed lungs, MRSA, complications from esophageal surgery and the everyday difficulty of clearing her lungs. “I’m prone to mucus plugs, which collapse the lung,” she says. “I was in the ICU on a trach when I got my first pneumonia, shortly after the initial surgery. The pneumonia came with MRSA, which has been an ongoing problem, as it flares up every time I run into lung problems.” Like many people with SCI/D, Miller’s main problem is simply not having the lung power to expel the secretions, which often leads to respiratory distress and pneumonia.

While respiratory diseases account for only 3 percent of all deaths in the general population, those same respiratory diseases account for more than 22 percent of all deaths in people with long-term SCI. And that’s only part of the picture according to Dr. Stephen Burns, who is the director of the SCI Service at the VA Puget Sound Health Care System and an associate professor at the University of Washington Department of Rehabilitation Medicine. “Because people die at a somewhat younger age with SCI, especially those with higher level injuries, the actual difference in risk is much greater,” he says. “The average person with an SCI’s risk of dying of pneumonia is 37 times higher than in the general population.”

Those statistics raise the questions: What are the causes of SCI respiratory diseases (especially pneumonia)? What is most effective in treating pneumonia once you contract it? And what can we do to prevent respiratory diseases?

The Basics of Breathing
Respiratory infections are much more prevalent for people with SCI and neuromuscular disease due to the mechanics of breathing. The main muscle used in breathing in (inspiration) is the diaphragm, which is innervated at C3-5. People with central nervous systems compromised above C3 usually require a ventilator for breathing, while people with C3-5 injuries are able to take small breaths. Those with impairments below C5 are able to take deeper breaths.

However, infection problems often stem from the inability to adequately move air out of the lungs (expiration). Expiration requires both intercostal and abdomina