Expiratory respiratory muscle weakness can lead to ineffective cough, retained upper airway secretions, and pulmonary infection (Miller and others 2009a)
Miller and others 2009a
Mechanical insufflation/exsufflation may be considered to clear secretions in patients with ALS who have reduced peak cough flow, particularly during an acute chest infection (Level C).
There are insufficient data to support or refute high frequency chest wall oscillation for clearing airway secretions in patients with ALS (Level U).
Medications with mucolytics like guaifenesin or N-acetylcysteine, a B-receptor antagonist (such as metoprolol or propanolol), nebulized saline, or an anticholinergic bronchodilator such as ipratropium are widely used; however, no controlled studies exist in ALS.
MND Australia 2011
Atrovent via a nebuliser may be helpful in the early stages of difficulty with secretions
