What is the importance of a cough assistant in ALS treatment?

Cough assistants (known as mechanical insufflator-exsufflators, MIEs) were established back in the 1990s. Their importance in the treatment of ALS is still underestimated, despite their longer availability. The use of a cough assistant is the most important treatment measure when ALS has reached the respiratory muscles and there is cough deficiency (reduced ability to cough up effectively).

There are two phases in the use of the cough assistant: In the first phase, the device produces a strong flow of air into the lungs via a tube and a mask (inhalation, known as insufflation). In the second phase, the device generates a sudden and strong negative pressure (exhalation, known as exsufflation). In the first phase of positive pressure ventilation, the ribs (and the entire chest) are lifted. The joints (and the associated joint capsules, tendons and muscles) are stretched (“stretching” in the joints between the spine and ribs). The device-supported inhalation is also associated with strong ventilation of the lung tissue and previously adhered lung areas (atelectasis). The subsequent device-assisted exhalation is primarily used to remove bronchial secretions.

Overall, the cough assistant is important for supporting three functions: 1) the mobility of the respiratory muscles (physiotherapy of the rib joints); 2) the improved ventilation of the lung tissue (reduction of atelectasis) and 3) the assisted expectoration of bronchial secretions (secretion management). Chest mobility and ventilation of the lung tissue is achieved by insufflation (powerful airflow into the lungs), while the removal of secretions is produced by exsufflation (powerful and sudden suction of air with negative pressure). In the future, it is to be expected that the method of cough assistants