At Home and on Demand Mechanical Cough Assistance Program for Patients With Amyotrophic Lateral Sclerosis

Abstract

An on-demand consult and MI-E access program can avoid hospitalizations for patients with amyotrophic lateral sclerosis with significant cost savings.

Using technology to improve access to specialist care in amyotrophic lateral sclerosis: A systematic review

“…However, according to the five year analysis, cost savings were made as nurses took over the roles of physicians with one nurse able to manage a caseload of 25 patients costing an estimated !105-108 per patient per month (47,49). Cost savings were also reported when the same telehealth system was used to detect respiratory exacerbations to supply Cough Assist machines (50). The service was reported to have prevented 30…”

“…The same Italian telehealth system was used to monitor 39 patients with ALS to identify respiratory exacerbations which would trigger the provision of a mechanical insufflation-exsufflation device ÒCough AssistÓ (50). 12 patients with ALS received cough assist on 47 occasions.…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…Among different technologies, video-conferencing can vastly increase the provision of patients ( particularly those in rural/ remote areas) with previously difficult access to services [75,76]. An on-demand tele-consult and mechanical insuflator-exsuflator device access programme avoided hospitalisations due to severe airway encumbrance for patients with ALS with significant cost savings [69].…”

The Use of Mechanical Insufflation-Exsufflation Via Artificial Airways

“…1,2,5,20 In addition, insufflation-exsufflation may prevent hospitalizations 18,19 and avoid the need for tracheostomy or intubation. 12 It reduces dyspnea, 11 shortens upper-airway-clearance sessions, 16 and stabilizes or improves blood gases.…”

“…[14][15][16][17][18][19][20][21][22][23] The particularity of insufflation-exsufflation is that it provides a mechanical assistance to compensate for deficits in both the inspiratory and expulsive phase of cough in patients with low respiratory muscle strength. Often associated with noninvasive mechanical ventilation, 1,19,22 insufflation-exsufflation is used in adults, children, and even infants. 22 To my knowledge, 3 insufflation-exsufflation devices are available on the market: CoughAssist (Philips Respironics, Murrysville, Pennsylvania); Pegaso (Dima Italia, Bologna, Italia); and Clearway (B&D Electromedical, Warwickshire, United Kingdom).…”