Observational studyThorax2017
Laryngeal response patterns influence the efficacy of mechanical assisted cough in amyotrophic lateral sclerosis.
Observational study in Thorax, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 37 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Systematic Laryngoscopic Evaluation of Upper Airways in Ventilated Amyotrophic Lateral Sclerosis (ALS) Patients in Portugal and in Norway
Can Ultrasound Imaging of Both Upper Airways and Diaphragm be Used to Guide Efficacy on Non-invasive Ventilation and Cough Assist
Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it, 120 citations in OpenAlex.
- Evidence for Beneficial Effect of Daily Use of Mechanical Insufflation-Exsufflation in Patients With Neuromuscular Diseases.Respiratory care · 2023Pooled it
- Can laryngeal ultrasound detect laryngeal movements during mechanically assisted cough?ERJ open research · 2026Article
- Early career member highlights from the ERS Respiratory Failure and Mechanical Ventilation Conference 2026.Breathe (Sheffield, England) · 2026Article
- Laryngeal Responses During Non-Invasive Ventilation in Stable Chronic Obstructive Pulmonary Disease: An Observational Study.International journal of chronic obstructive pulmonary disease · 2026Observational
- A Novel Device for Pulmonary Expansion Under Simulated Healthy and Neuromuscular Conditions: A Bench Simulation Study.Medical devices (Auckland, N.Z.) · 2026Article
- Exploring upper airway and laryngeal resistance to noninvasive ventilation in healthy awake adults.Physiological reports · 2025Article
- Exploring mechanisms of behavior change for healthcare professionals in cough and secretion management in ALS.Neurodegenerative disease management · 2025Article
- Mechanical insufflation-exsufflation use in neuromuscular disease: a single centre cohort study.BMJ open respiratory research · 2025Observational
- Patients and treatments in a neuropalliative outpatient clinic: an analysis of clinical routine data from five years of care.Frontiers in neurology · 2025Article
- Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2024.Breathe (Sheffield, England) · 2024Article
- Precision in Practice: Enhancing MI-E Therapy Evaluation for Improved Patient Outcomes, Excluding Speech and Swallowing. Reply to Allen et al. Comment on "Chatwin et al. Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders.Journal of clinical medicine · 2024Article
- Practical recommendations for swallowing and speaking during NIV in people with neuromuscular disorders.Acta myologica : myopathies and cardiomyopathies : official journal of the Mediterranean Society of Myology · 2024Review
- Article
- Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders.Journal of clinical medicine · 2024Review
- Pilot observational cohort study to determine whether waveform and flow traces from mechanical insufflation-exsufflation (MI-E) can be used to identify laryngeal responses to MI-E and thus optimise treatment algorithms in neuromuscular patients in a tertiary centre: a protocol description.BMJ open respiratory research · 2024Article
- Mechanically assisted cough strategies: user perspectives and cough flows in children with neurodisability.ERJ open research · 2024Article
- The complexity of multidisciplinary respiratory care in amyotrophic lateral sclerosis.Breathe (Sheffield, England) · 2023Review
- Airway clearance in patients with neuromuscular disease.Paediatric respiratory reviews · 2023Review
- Vocal cord dysfunction/inducible laryngeal obstruction-2022 Melbourne Roundtable Report.Respirology (Carlton, Vic.) · 2023Review
- Comparison of Four Mechanical Insufflation-Exsufflation Devices: Effect of Simulated Airway Collapse on Cough Peak Flow.Respiratory care · 2023Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMost patients with amyotrophic lateral sclerosis (ALS) are treated with mechanical insufflation-exsufflation (MI-E) in order to improve cough. This method often fails in ALS with bulbar involvement, allegedly due to upper-airway malfunction. We have studied this phenomenon in detail with laryngoscopy to unravel information that could lead to better treatment.
methodsWe conducted a cross-sectional study of 20 patients with ALS and 20 healthy age-matched and sex-matched volunteers. We used video-recorded flexible transnasal fibre-optic laryngoscopy during MI-E undertaken according to a standardised protocol, applying pressures of ±20 to ±50 cm H
resultsAt the supraglottic level, all patients with ALS and bulbar symptoms (n=14) adducted their laryngeal structures during insufflation. At the glottic level, initial abduction followed by subsequent adduction was observed in all patients with ALS during insufflation and exsufflation. Hypopharyngeal constriction during exsufflation was observed in all subjects, most prominently in patients with ALS and bulbar symptoms. Healthy subjects and patients with ALS and no bulbar symptoms (n=6) coordinated their cough well during MI-E.
conclusionsLaryngoscopy during ongoing MI-E in patients with ALS and bulbar symptoms revealed laryngeal adduction especially during insufflation but also during exsufflation, thereby severely compromising the size of the laryngeal inlet in some patients. Individually customised settings can prevent this and thereby improve and extend the use of non-invasive MI-E.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.