Why can respiratory failure occur in Duchenne muscular dystrophy?

In Duchenne muscular dystrophy (DMD), respiratory failure occurs primarily because of the progressive weakening of the diaphragm and other muscles involved in breathing.1

DMD is caused by the absence of dystrophin, a critical protein that protects muscle cell membranes during contraction. Without this protein, muscle cells throughout the body—including skeletal, heart, and diaphragm muscles—experience weakened membranes, leading to progressive degradation and the replacement of muscle tissue with fat and fibrous tissue. As the diaphragm and associated respiratory muscles weaken, the individual's ability to breathe effectively is compromised.12

To manage this decline, medical professionals typically prescribe a BiPAP (bilevel positive airway pressure) machine for nighttime use, with support often becoming necessary during the day as the condition progresses. Historically, respiratory failure or associated pulmonary infections have been leading causes of death in individuals with DMD.12