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Chronic respiratory care for neuromuscular diseases in adults

¹ Respiratory intensive Care and Pulmonary Diseases Unit, Cardio-Thoracic Dept, University Hospital Pisa, and ² Pulmonary Rehabilitation and Long Term Weaning Unit, Auxilium Vitae, Volterra, Italy.

CORRESPONDENCE: N. Ambrosino, Dipartimento Cardio-Toracico. Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello 56127 Pisa, Italy. E-mail: n.ambrosino{at}ao-pisa.toscana.it

Keywords: Chronic respiratory insufficiency, chronic ventilatory support, cough capacity, health-related quality of life, home ventilation, inspiratory muscles

Received: December 1, 2008
Accepted January 5, 2009

Neuromuscular diseases (NMD) may affect respiratory muscles, leading to respiratory failure. Studies show that long-term noninvasive mechanical ventilation (NIV) improves symptoms, gas exchange, quality of life and survival. NIV improved these parameters in muscular dystrophies and also in patients with amyotrophic lateral sclerosis without severe bulbar dysfunction. NIV should be started at the onset of nocturnal hypoventilation. In selected cases, NIV may be simpler, better accepted by patients and cheaper than invasive mechanical ventilation, but it cannot be used as an alternative. Tracheostomy may be preferred by patients unable to protect their airways and wishing to survive as long as possible, or by ventilator-dependent patients.

Glossopharyngeal breathing consists of taking air and propelling it into the lungs. Chest percussions and vibrations can help to mobilise airway secretions but they cannot substitute coughing. Manually assisted coughing requires substantial lung inflation through air stacking or deep lung insufflation, followed by an abdominal thrust with open glottis. The combination of mechanical in-exsufflation with an abdominal thrust is a mechanically assisted cough.

In conclusion, recent advances in respiratory care of NMD have improved prognosis and many caregivers have changed from a traditional noninterventional to a more aggressive, supportive approach.