Revue médicale suisse
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Specialized and multidisciplinary care is needed for patients with amyotrophic lateral sclerosis (ALS). Respiratory failure secondary to respiratory muscle dysfunction, ineffective cough, weight loss and progressive loss of autonomy should always be sought and explored. ⋯ Patients should be informed clearly as to the nature and evolution of ALS, and as to the potential benefits and disadvantages associated with each treatment modality in order to be involved in therapeutic decisions. This evidence-based review focuses on respiratory care of patients with ALS.
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Medical use of chronic opioids has recently increased in Switzerland. Even though their effect on daytime vigilance tends to disappear after some time, 70% of chronic opioid users will suffer from sleep disordered breathing. ⋯ More sophisticated ventilatory modes such as bilevel ventilation with backup respiratory rate or adaptive servoventilation are often required. Older patients with concomitant COPD or obstructive sleep apnea are at higher risk of developing nocturnal breathing disorders.