A 52-Year-Old Man With Daytime Sleepiness, Sialorrhea, and Facial Fasciculations

Bronchopleural Fistula or Alveolopleural Fistula?

“…Singh and Agarwal for their insightful comments regarding our report of placing a removable endobronchial valve to facilitate closure of a bronchopleural fistula (BPF). 1 We are in full agreement that precise terminology should be used when describing the underlying pathophysiology of persistent air leaks. Unfortunately, the accompanying video was not originally published as an on-line supplement as intended.…”

“…We read with interest the article by Feller-Kopman et al 1 (July 2006), who report the use of an endobronchial valve for the treatment of persistent air leak. We congratulate the authors on the novel use of the device.…”

“…Limiting amyotrophic lateral sclerosis patients to using lowspan bilevel positive airway pressure to treat "sleep-disordered breathing" invariably results in respiratory failure and death or tracheotomy. 1 On the other hand, portable volume ventilators can initially rest inspiratory muscles and eventually be used for continuous ventilatory support via 15-mm mouthpieces and nasal or oral interfaces (NIV). 2 The advantages of using volume modes rather than pressure modes is that they permit independent "air stacking" to mobilize lung and chest wall tissues to maintain lung compliance and facilitate coughing.…”

“…We acknowledge the comments by Dr. Bach regarding our recent article in CHEST (June 2006). 1 Although respiratory problems are the main cause of death in patients with amyotrophic lateral sclerosis (ALS), many patients do not receive appropriate and timely management of their respiratory problems. 2 The purpose of discussing our case was to highlight sleepdisordered breathing as an important presentation in patients with the bulbar form of ALS.…”