Noninvasive Ventilation Prolongs Life in ALS

In a study demonstrating the benefits of noninvasive (non-tracheostomy) ventilation, Daniele Lo Coco at Palermo (Italy) University and colleagues found that this intervention slowed the decline in respiratory function and made a significant difference in survival time in people with amyotrophic lateral sclerosis (ALS).

A British study published earlier this year (see “NIV Improves Quality of Life”) found that noninvasive ventilation improved both survival and quality of life in people with moderate or no weakness of the mouth and throat muscles, and that it improved quality of life in all patients.

In this new study of 71 ALS patients, published online Aug. 9 in Neurology, the average survival time for people who could tolerate a positive pressure noninvasive ventilation (NIPPV) device was 18 months after starting to use it, compared to six months for those unable to tolerate the device.

The researchers defined tolerance as being able to use a Respironics, bilevel, positive pressure device for at least four hours a day. NIPPV-tolerant patients used the device an average of seven hours a day, while intolerant patients used it an average of two hours a day.

Study participants with mild to moderate bulbar (mouth and throat) muscle symptoms were six times more likely to tolerate NIPPV than those with severe bulbar involvement.

The researchers aren’t certain of the precise mechanism by which NIPPV slows the decline in respiratory function. They speculate that the benefit could derive from the rest given to respiratory muscles by the ventilatory assistance, and/or to improvement in tissue elasticity or opening of small air sacs in the lungs.