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  1. Muhammad Khizar Rafiq,
  2. Michael Bradburn,
  3. Alison Proctor,
  4. Catherine Billings,
  5. Stephen Bianchi,
  6. Christopher McDermott,
  7. Pamela Shaw
  1. University of Sheffield


Background There is no clear consensus about how best to enhance cough in patients with ALS.

Methodology 40 eligible ALS patients with respiratory failure were randomised to the breath-stacking BS technique (n=21) or to mechanical insufflator/exsufflator MI-E (n=19).

Findings There were 13 episodes of chest infection in the BS group and 19 episodes in MI-E group (p=0.92), requiring 90 and 95 days of antibiotics respectively (p=0.34). The mean duration of symptoms per chest infection was 6.9 days in the BS group and 3.9 days in MI-E group (p=0.16). There were six episodes of hospitalisation in each group (p=0.64). The chance of hospitalisation, in the event of a chest infection was 0.46 in the BS group and 0.31 in MI-E group (p=0.47). Median survival in the BS group was 535 days and 266 days in MI-E group (p=0.34). The QoL was maintained above 75% of baseline for a median of 329 days in the BS group and 205 days in MI-E group (p=0.41).

Interpretation These results suggest non-inferiority of the BS to MI-E. We recommend that the BS technique is prescribed as a low cost, first-line intervention.


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