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Airway secretions

Expiratory respiratory muscle weakness can lead to ineffective cough, retained upper airway secretions, and pulmonary infection (Miller and others 2009a).

Retained secretions in the mouth and pharynx, accompanied with weakened cough, further compromise the airway and can add to feelings of discomfort and panic (MND Australia 2017).

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 2017

Atrovent via a nebuliser may be helpful in the early stages of difficulty with secretions.

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