A comparison of assisted cough techniques in stable patients with severe respiratory insufficiency due to amyotrophic lateral sclerosis

Authors:
  • JGJean-Louis Golmard
    Jean-Louis Golmard
  • FSFrançois Salachas
    François Salachas
  • ECEusebi Chiner
    Eusebi Chiner
  • CMCapucine Morelot-Panzini
    Capucine Morelot-Panzini
  • VMVincent Meninger
    Vincent Meninger
  • CLCatherine Lamouroux
    Catherine Lamouroux
  • TSThomas Similowski
    Thomas Similowski
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Abstract
Cough can be impaired in ALS. This can result in peak cough flows (PCFs) too low for an adequate airway clearance (p = 0.0005). In the bulbar group, these values were 42 (35–130) l/min versus 436 (244–630) l/min, respectively (p = 0.008), and 89 (40–106) l/min versus 491 (192–580) l/min, respectively, in the non-bulbar group (p = 0.019). There was no statistically significant difference between the bulbar and the non-bulbar groups. The in/exsufflator was not always the best tool. We conclude that capacity of coughing efforts to produce efficient peak cough flows can be dramatically improved with different tools, even in patients with very severe bulbar symptoms and that it appears useful to test an array of techniques to optimally tailor cough improvement techniques to individual patients.

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