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Role of Pulmonary Therapy

How does ALS affect breathing? The breathing muscles include the diaphragm (the major muscle that separates the chest from the abdomen, used for inhaling) and the muscles between the ribs. ALS involves breathing muscles, resulting in ineffective breathing or respiratory failure.

What pulmonary problems can I get with ALS?

  1. - Shortness of breath when walking or during rest
  2. - Inability to lie flat in bed
  3. - Poor strength of cough
  4. - Inability to clear secretions from the throat and lungs
  5. - Increased salivary secretions
  6. - Recurrent chest infections and pneumonia
  7. - Respiratory failure (high blood carbon dioxide level)

How can pulmonary therapy help breathing?

The pulmonary care team (including doctors and respiratory therapists) can work with you to monitor the strength of your respiratory muscles to diagnose early evidence of weakness. Provide breathing assistive devices, such as:

  1. -Suction machine to clear mouth and throat secretion
  2. -Non-invasive ventilation
  3. -In-Exsufflator
  4. -Flu vaccine and pneumovax (pneumonia vaccine)

What are some concerns regarding non-invasive ventilation?

  1. Mask is uncomfortable, puts pressure on the nose and face and makes you feel claustrophobic
  2. Causes dry nose
  3. Causes red eyes
  4. Machine is too noisy
  5. Air can leak from the mask
  6. Poor coordination of breathing

What are some recommendations to improve breathing?



1. Do not lie down immediately after eating.
2. Avoid eating large meals which can prevent diaphragm from expanding fully.
3. Maintaining good nutritional status is essential to ensure optimal functional capability of breathing muscles.


Exercise guidelines

Aerobic exercise can increase muscle efficiency and endurance by increasing heart rate, respiratory rate and overall cardiovascular fitness. Remember to exercise in moderation - exercising to the point of fatigue may actually result in increased muscle weakness.

Stretching exercises may help decrease the frequency or intensity of muscle cramping. These should be done daily to prevent pain and stiffness.

Range of motion exercises (ROM) help move the joints through their full range of motion. These should be performed actively, if possible, or passively if muscle weakness limits movement. These should be done daily to prevent pain and stiffness.

Strengthening exercises are not recommended. Working out with weights will not strengthen those muscles already weakened by ALS and could result in increased muscle weakness.

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