Monitoring and Management of Respiratory Function in Pompe Disease: Current Perspectives

Léa El Haddad,1 Mainur Khan,1 Rania Soufny,1 David Mummy,2 Bastiaan Driehuys,2 Wissam Mansour,3 Priya S Kishnani,4 Mai K ElMallah1 1Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA; 2Department of Radiology, Duke University Medical Center, Durham, NC, USA; 3Division of Pulmonary and Sleep Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; 4Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USACorrespondence: Mai K ElMallah, Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Box 2644, Durham, NC, 27710, USA, Tel +1-919-684-3577, Email mai.elmallah@duke.eduAbstract: Pompe disease (PD) is a neuromuscular disorder caused by a deficiency of acid alpha-glucosidase (GAA) – a lysosomal enzyme responsible for hydrolyzing glycogen. GAA deficiency leads to accumulation of glycogen in lysosomes, causing cellular disruption. The severity of PD is directly related to the extent of GAA deficiency – if no or minimal GAA is produced, symptoms are severe and manifest in infancy, known as infantile onset PD (IOPD). If left untreated, infants with IOPD experience muscle hypotonia and cardio-respiratory failure leading to significant morbidity and mortality in the first year of life. In contrast, late-onset PD (LOPD) patients have more GAA activity and present later in life, but also have significant respiratory function decline. Despite FDA-approved enzyme replacement therapy, respiratory insufficiency remains a major cause of morbidity and mortality, emphasizing the importance of early detection and management of respiratory complications. These complications include impaired cough and airway clearance, respiratory muscle weakness, sleep-related breathing issues, and pulmonary infections. This review aims to provide an overview of the respiratory pathology, monitoring, and management of PD patients. In addition, we discuss the impact of novel approaches and therapies on respiratory function in PD.Keywords: Pompe disease, respiratory complications, respiratory monitoring, respiratory therapy