Which bronchial hygiene strategy is suitable for patients with neuromuscular disorders like ALS?

Mechanical insufflation-exsufflation (MIE) is particularly suitable for patients with neuromuscular disorders like ALS because it helps clear secretions effectively when the patients have compromised respiratory muscle strength. In ALS, the progressive degeneration of motor neurons leads to muscle weakness, including the muscles used for effective coughing. MIE employs a machine that delivers positive pressure to inflate the lungs, followed by a rapid shift to negative pressure to simulate a cough and facilitate the removal of secretions. This technique enhances airway clearance without requiring the patient to generate the forceful cough that they may not be capable of achieving due to their condition.

While Active Cycle of Breathing (ACB), Postural drainage and percussion, and Positive Expiratory Pressure (PEP) are valuable techniques for airway clearance, they often rely on the patient's ability to generate adequate force and control airflow, which can be significantly diminished in individuals with neuromuscular disorders. Thus, MIE stands out as the most effective strategy for managing bronchial hygiene in this patient population.