What treatment options are available for hypoventilation in ALS?

In the case of respiratory weakness (hypoventilation), mask ventilation is a suitable option to support difficult breathing. The weakness of the respiratory muscles means that the breathing capacity (the volume of inhaled and exhaled air) is reduced.

Mask ventilation can at least partially compensate for the respiratory deficit. Mask ventilation is referred to as non-invasive ventilation (NIV) or non-invasive ventilation therapy (NIBT). Another effect of respiratory insufficiency is coughing deficiency. Coughing is an important function of the body to “clear” the airways of secretions. Coughing is a complex and energy-intensive process of the respiratory system, which is performed by the muscles of the larynx and trunk as well as the abdominal muscles. In ALS, all of these muscles can be impaired in their function, thus reducing the coughing function.

If the cough reflex is restricted, the “cough assistant” device can be used to produce a cough reflex several times a day (with the aid of the device). Mask ventilation and the cough assistant are considered non-invasive methods of respiratory support. In certain constellations, especially if the support provided by non-invasive respiratory aids is not sufficient, invasive ventilation via the surgical creation of a tracheostomy and ventilation (mechanical ventilation) via a tracheal cannula may be considered.

In addition to medical support in the form of mask ventilation, a cough assistant or mechanical ventilation, medication is also available to alleviate symptoms of respiratory effort (palliative medical treatment). The individual assessment of suitable treatment and support procedures is one of the central issues in outpatient clinics, practices and hospitals that specialize in the care of people with ALS.