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NEUROLOGY 2003;61:1285-1287
© 2003 American Academy of Neurology
Brief Communications

Cough augmentation in amyotrophic lateral sclerosis

N. Mustfa, MBBS, M. Aiello, MD, R. A. Lyall, MBBS, D. Nikoletou, MSc, D. Olivieri, MD, P. N. Leigh, PhD, A. C. Davidson, MD, M. I. Polkey, PhD and J. Moxham, MD

From the Respiratory Muscle Laboratory (N. Mustfa, R.A. Lyall, and D. Nikoletou, and Drs. Davidson and Moxham), Guy’s, King’s and St. Thomas’ School of Medicine, King’s College Hospital, London; Department of Respiratory Medicine (Drs. Aiello and Olivieri), University of Parma, Italy; The King’s MND Care and Research Centre, Department of Neurology, The Institute of Psychiatry (Dr. Leigh), Guy’s, King’s College, London; and Respiratory Muscle Laboratory (Dr. Polkey), The Royal Brompton Hospital, London, UK.

Address correspondence and reprint requests to N. Mustfa, Respiratory Muscle Laboratory, Guy’s, King’s and St. Thomas’ School of Medicine, King’s Hospital, Bessemer Rd., Denmark Hill, London SE5 9PJ, UK; e-mail: naveed{at}doctors.org.uk

Cough flows and pressures were measured during cough augmentation in healthy subjects and patients with bulbar and nonbulbar amyotrophic lateral sclerosis. Manual assistance increased flow 11% in bulbar (p < 0.01) and 13% in nonbulbar (p < 0.001) patients. Mechanical insufflation-exsufflation increased flow 17% in healthy subjects (p < 0.05), 26% (p < 0.001) in bulbar, and 28% (p < 0.001) in nonbulbar patients. The greatest improvements were in patients with the weakest coughs. Patient group and level of weakness influenced the effect of augmentation.

Received December 4, 2002. Accepted in final form July 22, 2003.




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