People with amyotrophic lateral sclerosis (ALS) usually have either primarily skeletal muscle ALS where the arms and legs become weak along with the breathing and coughing muscles, or "bulbar" ALS where the throat muscles become weak causing loss of speech and swallowing. People with the former type often develop colds that cause airway secretions that they cannot effectively cough out. This causes pneumonia and respiratory failure. At this point they are hospitalized and told that they need tracheostomy tubes. However, with the use of inspiratory and expiratory muscle aids this is always avoidable.
We have removed the tracheostomy tubes of ventilator users with ALS and switched them to using safer and more comfortable inspiratory muscle aids. Since we cannot assist throat muscles the way we can the inspiratory and coughing muscles, we can do less for bulbar ALS patients. However, the cough machine can at times be effective to prevent pneumonia and respiratory failure.
For patients with tracheostomy tubes, the cough machine can also be used through the tube to eliminate the need to suction through the tube. Exsufflation through a tube is much less uncomfortable than suctioning.
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