Prevention and management of respiratory disease in cerebral palsy: Evidence-based strategies and future recommendations

Abstract

Individuals with cerebral palsy (CP) are at an increased risk of developing respiratory diseases due to various factors, including motor impairments, postural abnormalities, and comorbidities, such as dysphagia and gastroesophageal reflux disease. This paper reviews evidence-based strategies and recommendations for the prevention and management of respiratory diseases in young adults with CP. It highlights the importance of early screening, vaccination, and infection control, as well as the role of pulmonary rehabilitation and physical therapy in improving respiratory function. Non-invasive ventilation and pharmacological management, including bronchodilators and mucolytics, are critical for individuals with compromised lung function. Multidisciplinary care, postural management, and swallowing therapy are key components of a comprehensive treatment approach. In addition, innovations in telemedicine and caregiver education are emerging as effective tools to enhance respiratory care and prevent complications. While challenges remain in accessibility and training, future directions, such as personalized medicine and rehabilitation technologies, offer promising solutions to further improve the respiratory health of individuals with CP. This review underscores the importance of early intervention, coordinated care, and ongoing support to optimize outcomes for individuals with CP and reduce the burden of respiratory diseases.

Keywords

Cerebral palsy / Clinical outcomes / Neurological disorder / Non-invasive ventilation / Respiratory disease

References

[1] Rosenbaum P, Paneth N, Leviton A, et al. A report: The definition and classification of cerebral palsy. Dev Med Child Neurol. 2007; 49(3):8-14. doi: 10.1111/j.1469-8749.2007.00001.x

[2] Centers for Disease Control and Prevention. Data and Statistics for Cerebral Palsy; 2022. Available from:https://archive.cdc.gov/www_cdc_gov/ncbddd/cp/data.html [Last accessed on 2025 Jun 10].

[3] Olusanya BO, Gladstone M, Wright SM, et al. Cerebral palsy and developmental intellectual disability in children younger than 5 years: Findings from the GBD-WHO rehabilitation database 2019. Front Public Health. 2022; 10:894546. doi: 10.3389/fpubh.2022.894546

[4] Boel L, Pernet K, Toussaint M, et al. Respiratory morbidity in children with cerebral palsy: An overview. Dev Med Child Neurol. 2019; 61(6):646-653. doi: 10.1111/dmcn.14060

[5] Givon U. Beyin felcinde kas zayifliği. [Muscle weakness in cerebral palsy]. Acta Orthop Traumatol Turc. 2009; 43(2): 87-93. doi: 10.3944/aott.2009.087

[6] Spoto G, Accetta AS, Grella M, Di Modica I, Nicotera AG, Di Rosa G. Respiratory comorbidities and complications of cerebral palsy. Dev Neurorehabil. 2024; 27(5-6):194-203. doi: 10.1080/17518423.2024.2374959

[7] Yoon SY, Kim YW, Choi JY. Pulmonary rehabilitation in a patient with bronchiectasis and underlying cerebral palsy: A case presentation. PM R. 2018; 10(5):548-551. doi: 10.1016/j.pmrj.2017.09.009

[8] Marpole R, Blackmore AM, Gibson N, Cooper MS, Langdon K, Wilson AC. Evaluation and management of respiratory illness in children with cerebral palsy. Front Pediatr. 2020; 8:333. doi: 10.3389/fped.2020.00333

[9] Cloake T, Gardner A. The management of scoliosis in children with cerebral palsy: A review. J Spine Surg. 2016; 2(4):299-309. doi: 10.21037/jss.2016.09.05

[10] Kürtül Çakar M, Cinel G. The respiratory problems of patients with cerebral palsy requiring hospitalization: Reasons and solutions. Pediatr Pulmonol. 2021; 56(6): 1626-1634. doi: 10.1002/ppul.25306

[11] Fainardi V, Rizzo L, Zambelli G, et al. Airway colonization in children with medical complexity: Challenges and management strategies. J Clin Med. 2025; 14(3):848. doi: 10.3390/jcm14030848

[12] Dias BLS, De Lima FM. Respiratory system impairments in children with cerebral palsy: Outpatient surveillance, diagnosis, and treatment. Med Res Arch. 2021; 9(11). doi: 10.18103/mra.v9i11.2594

[13] El Banna EH, El Hadidy EI, Ali WM. Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: A systematic review. Bull Fac Phys Ther. 2020; 25(1):18. doi: 10.1186/s43161-020-00016-6

[14] Guyard A, Fauconnier J, Mermet MA, Cans C. Impact on parents of cerebral palsy in children: A literature review. Arch Pediatr. 2011; 18(2):204-214. doi: 10.1016/j.arcped.2010.11.008

[15] Romeo DM, Venezia I, Pede E, Brogna C. Cerebral palsy and sex differences in children: A narrative review of the literature. J Neurosci Res. 2023; 101(5):783-795. doi: 10.1002/jnr.25020

[16] Sorhage A, Keenan S, Chong J, et al. Respiratory health inequities among children and young adults with cerebral palsy in aotearoa New Zealand: A data linkage study. J Clin Med. 2022; 11(23):6968. doi: 10.3390/jcm11236968

[17] Gibson N, Blackmore AM, Chang AB, et al. Prevention and management of respiratory disease in young people with cerebral palsy: Consensus statement. Dev Med Child Neurol. 2021; 63(2):172-182. doi: 10.1111/dmcn.14640

[18] Grychtol R, Chan EY. Use of non-invasive ventilation in cerebral palsy. Arch Dis Child. 2018; 103(12):1170-1177. doi: 10.1136/archdischild-2017-313959

[19] Calderone A, Militi D, Cardile D, Corallo F, Calabrò RS, Militi A. Swallowing disorders in cerebral palsy: A systematic review of oropharyngeal Dysphagia, nutritional impact, and health risks. Ital J Pediatr. 2025; 51(1):57. doi: 10.1186/s13052-025-01903-1

[20] Ambrosino N, Fracchia C. The role of tele-medicine inpatients with respiratory diseases. Expert Rev Respir Med. 2017; 11(11):893-900. doi: 10.1080/17476348.2017.1383898

[21] Bax M, Tydeman C, Flodmark O. Clinical and MRI correlates of cerebral palsy: The European cerebral palsy study. JAMA. 2006; 296(13):1602-1608. doi: 10.1001/jama.296.13.1602

[22] Brandenburg JE, Fogarty MJ, Sieck GC. Why individuals with cerebral palsy are at higher risk for respiratory complications from COVID-19. J Pediatr Rehabil Med. 2020; 13(3):317-327. doi: 10.3233/prm-200746

[23] Shiver AL, Shaw KA, Murphy JS, Fletcher ND. Gastrostomy tubes in children with nonambulatory cerebral palsy and neuromuscular scoliosis: An enemy or an ally? J Pediatr Orthop Soc North Am. 2021; 3(3):259. doi: 10.55275/jposna-2021-259

[24] Peneva P, Pancheva R, Nikolova SP. Unveiling respiratory challenges in cerebral palsy: A comprehensive review. Biomed Rev. 2023; 34:121-132. doi: 10.14748/bmr.v34.9620

[25] Desai B, Lesser DJ, Sunwoo BY. Managing pulmonary complications in adults with cerebral palsy: A vulnerable transition. CHEST Pulm. 2023; 1(3):100025. doi: 10.1016/j.chpulm.2023.100025

[26] Micheletto C, Aliberti S, Andreoni M, et al. Vaccination strategies in respiratory diseases: Recommendation from AIPO-ITS/ETS, SIMIT, SIP/IRS, and SItI. Respiration. 2025; 104(8):556-574. doi: 10.1159/000544919

[27] Greenhalgh T, MacIntyre CR, Baker MG, et al. Masks and respirators for prevention of respiratory infections: A state of the science review. Clin Microbiol Rev. 2024; 37(2):e00124-e00123. doi: 10.1128/cmr.00124-23

[28] Myers LL, Nerminathan A, Fitzgerald DA, et al. Transition to adult care for young people with cerebral palsy. Paediatr Respir Rev. 2020; 33:16-23. doi: 10.1016/j.prrv.2019.12.002

[29] Keles MN, Elbasan B, Apaydin U, Aribas Z, Bakirtas A, Kokturk N. Effects of inspiratory muscle training in children with cerebral palsy: A randomized controlled trial. Braz J Phys Ther. 2018; 22(6):493-501. doi: 10.1016/j.bjpt.2018.03.010

[30] Alhumaid MM, Asiri FYI, Said MA, Haegele JA. The efficacy of physical activity or exercise among individuals with cerebral palsy: An umbrella review of systematic reviews. Complement Ther Med. 2025; 93:103228. doi: 10.1016/j.ctim.2025.103228

[31] Rezoagli E, Nova A, Carteaux G, et al. A clinical guide to non-invasive respiratory support in acute respiratory failure: Ventilation settings, technical optimization and clinical indications. Crit Care. 2025; 29(1):496. doi: 10.1186/s13054-025-05730-y

[32] Lam KF, Lam P. Tracheostomy in children with severe neurological impairment: A single-centre review. J Paediatr Respirol Crit Care. 2015; 11:4-11.

[33] Hocquigny A, Hugerot H, Ghanem R, et al. Mucoactive drugs and multiple applications in pulmonary disease therapy. Eur J Pharm Biopharm. 2024; 194:110-117. doi: 10.1016/j.ejpb.2023.12.001

[34] El-Sherbiny IM, Elbaz NM, Sedki M, Elgammal A, Yacoub MH. Magnetic nanoparticles-based drug and gene delivery systems for the treatment of pulmonary diseases. Nanomedicine (Lond). 2017; 12(4):387-402. doi: 10.2217/nnm-2016-0341

[35] Winkler R, Ciria M, Ahmad M, Plank H, Marcuello C. A review of the current state of magnetic force microscopy to unravel the magnetic properties of nanomaterials applied in biological systems and future directions for quantum technologies. Nanomaterials (Basel). 2023; 13(18):2585. doi: 10.3390/nano13182585

[36] Stocke NA, Meenach SA, Arnold SM, Mansour HM, Hilt JZ. Formulation and characterization of inhalable magnetic nanocomposite microparticles (MnMs) for targeted pulmonary delivery via spray drying. Int J Pharm. 2015; 479(2):320-328. doi: 10.1016/j.ijpharm.2014.12.050

[37] Blackmore AM, Gibson N, Cooper MS, Langdon K, Moshovis L, Wilson AC. Interventions for management of respiratory disease in young people with cerebral palsy: A systematic review. Child Care Health Dev. 2019; 45(5): 754-771. doi: 10.1111/cch.12703

[38] Oguntade HA, Nishath T, Owusu PG, Papadimitriou C, Sakyi KS. Barriers to providing healthcare to children living with cerebral palsy in Ghana: A qualitative study of healthcare provider. PLOS Glob Public Health. 2022; 2(12):e0001331. doi: 10.1371/journal.pgph.0001331

[39] Twagirumugabe T, Gashame DF, Uwamahoro DL, Riviello E. Advanced non-invasive respiratory support in resource-constrained settings: A narrative review. Crit Care. 2025; 29(1):492. doi: 10.1186/s13054-025-05688-x

[40] Rachamose N, Harvey C. The barriers to caring for a child living with cerebral palsy (CP) in rural Limpopo, South Africa. Disabilities. 2025; 5(1):11-18. doi: 10.3390/disabilities5010011

[41] Ben-Pazi H, Beni-Adani L, Lamdan R. Accelerating telemedicine for cerebral palsy during the COVID-19 pandemic and beyond. Front Neurol. 2020; 11:746. doi: 10.3389/fneur.2020.00746

[42] Coller RJ, Singh-Verdeflor K, Eickhoff J, et al. Preventing respiratory illness in cerebral palsy: Results of a pilot randomized controlled trial. PLoS One. 2025; 20(6):e0325970. doi: 10.1371/journal.pone.0325970

[43] Vitazkova D, Foltan E, Kosnacova H, et al. Advances in respiratory monitoring: A comprehensive review of wearable and remote technologies. Biosensors (Basel). 2024; 14(2):90. doi: 10.3390/bios14020090

[44] Paul S, Nahar A, Bhagawati M, Kunwar AJ. A review on recent advances of cerebral palsy. Oxid Med Cell Longev. 2022; 2022(1): 2622310. doi: 10.1155/2022/2622310