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NMES for Breathlessness in COPD — SCE Palliative Medicine MCQ

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ModerateRespiratory SymptomsNMES for Breathlessness in COPDSCE Palliative Medicine

A 70‑year‑old man with advanced COPD has intractable breathlessness despite maximal medical therapy and low‑dose morphine. His pulmonary rehabilitation team suggests a programme of neuromuscular electrical stimulation (NMES) for his quadriceps. What is the rationale?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Peripheral muscle deconditioning contributes significantly to exercise intolerance and breathlessness in COPD — NMES passively strengthens quadriceps without triggering ventilatory demand, improving functional capacity

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · A = shown as D

The correct answer is A. In advanced COPD, peripheral (quadriceps) muscle deconditioning is a major contributor to exercise limitation and breathlessness. NMES passively activates the quadriceps, improving muscle mass and strength without increasing ventilatory load – particularly valuable in palliative patients who cannot tolerate exertional dyspnoea. A UK double‑blind RCT demonstrated that NMES significantly improved 6‑minute walk distance by ~36 m and quadriceps function compared to placebo ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/26701362/?utm_source=openai)). NICE HealthTech guidance confirms NMES mimics exercise training by producing muscle contractions ([nice.org.uk](https://www.nice.org.uk/guidance/HTG549/chapter/2-the-condition-current-treatments-and-procedure?utm_source=openai)). The British Thoracic Society supports NMES as an adjunct in select patients unable to participate in conventional rehab ([thorax.bmj.com](https://thorax.bmj.com/content/68/Suppl_2/ii1?utm_source=openai)). Options B, C, D, and E are not supported by evidence: NMES has no direct effect on lung function, airway inflammation, aetiology (“cure”), or blood oxygen‑carrying capacity.

Reference: Maddocks M et al. Neuromuscular electrical stimulation to improve exercise capacity in patients with severe COPD: a randomised double‑blind, placebo‑controlled trial. Lancet Respir Med (2016). NICE HealthTech guidance HTG549 (2020). British Thoracic Society pulmonary rehabilitation guidelines (2013).