• Jesús Sancho, Enric Burés, Santos Ferrer, Elvira Bondía, and Emilio Servera.
• Respiratory Care Unit, Respiratory Medicine Department, Hospital Clinico Universitario, Valencia, Spain. jesus.sancho@uv.es.
• Respir Care. 2020 May 1; 65 (5): 596-602.

BackgroundAssisted coughing via mechanical in-exsufflation (MI-E) is a first-line treatment for secretion management in patients with amyotrophic lateral sclerosis (ALS) with unassisted CPF < 4.25 L/s. Some devices enable oscillations to be added to MI-E (MI-E+O). We sought to determine whether adding oscillations to MI-E enables a reduction in the use of invasive secretion management procedures (ie, bronchoscopy or tracheostomy) in subjects with ALS.MethodsWe conducted a 12-month, prospective, randomized follow-up study of subjects with ALS for whom assisted coughing techniques were indicated. One group was treated with oscillations in addition to MI-E (MI-E+O), and the other group was treated with conventional MI-E.Results29 subjects were included in the MI-E group and 27 subjects were included in the MI-E+O group. Five subjects (8.9%) required invasive techniques for secretion management (3 in the MI-E group and 2 in the MI-E+O group, P = .70). Treatment with MI-E+O did not alter the risk of invasive procedures (odds ratio 0.69, 95% CI 0.10-4.50, P = .70). The mean number of respiratory infections was 0.58 ± 0.16 in the MI-E group and 0.025 ± 0.08 in the MI-E+O group (P = .10). Survival was 8.96 ± 0.18 months in the MI-E group and 7.70 ± 0.70 months in the MI-E+O group (P = .10).ConclusionAdding oscillations to MI-E did not enable a reduction in the need to perform invasive procedures for secretion management in subjects with ALS.Copyright © 2020 by Daedalus Enterprises.

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