1	Respiratory Care in ALS Physiology of breathing Complications from respiratory muscle weakness in ALS Some questions asked by ALS patients and their caregivers Treatment options
2
3
4
5
6
7	The Effects of ALS on Respiratory System Hypoventilation/Shortness of breath Pneumonia syndromes Airway obstruction
8	The Effects of ALS on Respiratory System Hypoventilation syndrome Breathlessness Inability to cough and clear secretions Diminished voice volume
9	Respiratory insufficiency in ALS Shortness of breath when walking or during rest Inability to lie flat in bed Poor strength of cough Inability to clear secretions from the throat and lungs Increased salivary secretions Recurrent chest infections and pneumonia Respiratory failure (high blood carbon dioxide level) Poor sleep Fatigue Headache Anxiety, panic episodes Anorexia, unexpected weight loss
10	Question? Why do I feel short of breath when I lie down ?
11	Question? How is respiratory weakness diagnosed? Clinical Spirometry (FVC, MIP, MEP, MVV) Nocturnal pulse oxymetry Arterial blood gas
12	Question? What can be done about weakening respiratory muscles? Optimal nutrition Adequate rest Prevention of aspiration Prevention of infection (Flu shot, Pneumovaccine)
13
14	Question? What I do when my weak muscles fail to produce an effective cough ? Assist cough Cough machine (insufflation/exsufflation) Postural drainage Tracheostomy
15
16
17	Treatment Options 1. No mechanical support 2. Non invasive ventilation 3. Tracheostomy and mechanical ventilatory support
18
19
20	Question? Which option is best for me?
21	Thank You