Respiratory Issues in ALS

by Anne Markovich, RN, BSN on Fri, 2002-02-01 17:00

Anne Markovich, RN, BSN
Nurse Coordinator, Neuromuscular Disorders Program MDA Clinic, Northwestern University, Chicago
*Reprinted with permission from Chicago Cares, the MDA/ALS Division Newsletter from Chicago

Persons with ALS have many respiratory issues that are a direct result of their illness and the weakening of the muscles used for breathing and coughing.


While those with ALS are not truly more susceptible to pneumonia or flu than the general public, they do have a more difficult time dealing with the conditions if they should develop. Pneumonia and flu are caused by a bacterial or viral infection. Pneumonia may also be caused by aspiration of food/fluid into the lungs. It is important to be aware of the signs of pneumonia and respiratory forms of flu and to seek care before a crisis. The signs of pneumonia and respiratory flu are:

1. Coughing

2. Sputum production (that may be clear, yellow or green)

3. Chest discomfort with breathing

4. Chills/fever/sweating

To prevent pneumonia or flu

1. Obtain a yearly influenza vaccination (best received from middle October through early November) and a pneumonia vaccination (which provides protection for five to seven years from the date of injection). The influenza vaccine can be given at your MDA clinic visit with advance notice.

2. Patients who are having difficulty with liquids (choking or coughing) should use a thickener (such as ThickIT) to prevent aspiration into the lungs. Consider a swallow study for further evaluation of the issue. Talk to your MDA clinic team to discuss these options.

3. Seek medical advice and care early if symptoms should develop.


Secretions in the back of the throat (not to be confused with excess saliva which can occur in ALS) are often a problem in ALS, especially if they become very thick and cannot be coughed out. These secretions are generally a result of postnasal drip or drainage of sinus fluids in the throat.

To manage thick secretions

1. Increase fluid intake.

2. Use a humidifier in the bedroom each night, even if you have a humidifier on your furnace.

3. Use Robitussin (plain, no initials like DM, etc.), 1-2 teaspoons every six hours. This is to thin the secretions, not to treat cough, whether present or not.

4. Sip dark grape juice throughout the day. The grapes contain an enzyme that thins secretions. Do not drink more than three glasses per day as more will cause diarrhea.

5. Hot tea works to both thin out secretions and open up lung passages.

6. Papaya tablets can be used (available in the vitamin section of most drugstores), but they are sucked on like a lozenge, not swallowed. Do not take more than six per day as more also causes diarrhea. If you choke easily or have difficulty with tongue control/movement, this may not be a safe intervention for you.

7. A suction machine can also be useful in clearing away secretions once they are thinned out. The device used to suction is similar to what a dentist uses when he is working on your teeth to clear out the mouth.

8. If these suggestions are not successful, medication that is inhaled by means of a nebulizer (what people with asthma use) may be necessary to thin secretions. You should contact your MDA clinic to obtain details and orders for this type of intervention if it is appropriate for your circumstances.

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