Mechanical Insufflation Exsufflation and Lung Volume Recruitment in Amyotrophic Lateral Sclerosis: a Prospective Study of the Prescription Process, the Outcomes and the Experience
Mechanical Insufflation Exsufflation (M-IE) and Lung Volume Recruitment (LVR) increase cough strength in Amyotrophic Lateral Sclerosis (ALS). Changes in respiratory measures, morbidity, physical function and outcomes; participant's characteristics prescribed a M-IE and LVR device and their experience with devices are unknown. Finally, LVR adherence is difficult to measure. Aims/Objectives: The primary aim was to measure, respiratory measures, morbidity, physical function and outcome in an Irish
... outcome in an Irish ALS cohort. Secondary aims were to examine the characteristics of participants prescribed a device; to evaluate their experiences and to develop an electronic LVR adherence prototype. Methods: A prospective longitudinal observational cohort study evaluated 108 participants over one year. Respiratory measures, physical function and outcomes were measured. Characteristics were assessed at device prescription. A questionnaire evaluated experience. An electronic LVR adherence prototype was developed. Results: Participants (n=108), of mean age 62.05±11.47, were recruited. Sniff Nasal Inspiratory Pressure (SNIP), Slow Vital Capacity (SVC) percent predicted, Peak Cough Flow (PCF) and Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) declined significantly (p2O, 17.49%, 124.84L/min and 9.62 units per year respectively. One third reported a chest infection and 21 died. Participants prescribed a device had significantly lower average SNIP, SVC percent predicted, PCF and ALSFRS-R (p Conclusion: This is the first study to quantify the rate of decline of SNIP, SVC and PCF in an Irish ALS cohort and PCF in a large ALS cohort. Device prescription is detailed. This study provides a point of reference for clinicians and future trials. The electronic LVR adherence prototype has potential to be developed for clinical trials.