At home and on demand mechanical cough assistance program for patients with amyotrophic lateral sclerosis

Michele Vitacca, Mara Paneroni, Debora Trainini, Luca Bianchi, Giuliano Assoni, Manuela Saleri, Sonia Gilè, João C. Winck, Miguel R. Gonçalves

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To establish a cost-effective telephone-accessed consultation and mechanical in-exsufflation (MI-E) and manually assisted coughing, oximetry feedback program for 39 patients with amyotrophic lateral sclerosis. DESIGN: Rapid access to healthcare consultation and to MI-E was provided to treat episodes of distress as a result of secretion encumbrance not reversed by suctioning and associated with a decrease in oxyhemoglobin saturation (SpO2) baseline. Avoided hospitalizations, defined by relief of respiratory distress and return of SpO2 baseline to ≥95% by continuous ventilator use and assisted coughing, were recorded. Patient satisfaction was queried at 6 mos, and a cost analysis was performed of continuous vs. on demand MI-E use. RESULTS: Thirty-nine patients made a total of 1661 calls in 7.46 ± 5.8 mos of follow-up. Twenty-seven patients had 66 home care visits by a respiratory therapist for a total time commitment of 89.7 ± 99.3 min/patient/mo. Twelve patients, all ventilator users, were also brought mechanical in-exsufflators for mechanically assisted coughing for 47 respiratory episodes. Thirty hospitalizations were avoided. Seventy-five percent of the patients were extremely satisfied. Mean monthly cost per patient for on-demand telephone consultation, professional home healthcare visits, and MI-E as deemed necessary was €403 ± €420 or 59% less than for continuous MI-E rental. Hospitalization costs were also spared. CONCLUSIONS: An on-demand consult and MI-E access program can avoid hospitalizations for patients with amyotrophic lateral sclerosis with significant cost savings.

Original languageEnglish
Pages (from-to)401-406
Number of pages6
JournalAmerican Journal of Physical Medicine and Rehabilitation
Issue number5
Publication statusPublished - May 2010


  • Acute respiratory failure
  • Amyotrophic lateral sclerosis
  • Home care
  • Mechanically assisted coughing

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)


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