title: Absence of airway secretion accumulation predicts tolerance of noninvasive ventilation in subjects with amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  To assess factors that predict good tolerance of noninvasive ventilation (NIV), in order to improve survival and quality of life in subjects with amyotrophic lateral sclerosis.
  
  
  METHODS
  We conducted a prospective study in subjects with amyotrophic lateral sclerosis and requiring NIV. The primary end point was NIV tolerance at 1 month. Subjects, several of whom failed to complete the study, were classified as "tolerant" or "poorly tolerant," according to the number of hours of NIV use (more or less than 4 h per night, respectively).
  
  
  RESULTS
  Eighty-one subjects, 73 of whom also attended the 1-month follow-up visit, participated over 34 months. NIV tolerance after the first day of utilization predicted tolerance at 1 month (77.6% and 75.3% of subjects, respectively). Multivariate analysis disclosed 3 factors predicting good NIV tolerance: absence of airway secretions accumulation prior to NIV onset (odds ratio 11.5); normal bulbar function at initiation of NIV (odds ratio 8.5); and older age (weakly significant, odds ratio 1.1).
  
  
  CONCLUSIONS
  Our study reveals 3 factors that are predictive of good NIV tolerance, in particular the absence of airway secretion accumulation, which should prompt NIV initiation before its appearance.
authors: Service d'Electroneuromyographie et Service de Neurologie C, Centre Sclérose Latérale Amyotrophique de Lyon, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
authors: Nadia
authors: N
authors: Vandenberghe
authors: Anne-Evelyne
authors: AE
authors: Vallet
authors: Thierry
authors: T
authors: Petitjean
authors: Pierre
authors: P
authors: Le Cam
authors: Stéphane
authors: S
authors: Peysson
authors: Claude
authors: C
authors: Guérin
authors: Frédéric
authors: F
authors: Dailler
authors: Sylvie
authors: S
authors: Jay
authors: Vincent
authors: V
authors: Cadiergue
authors: Françoise
authors: F
authors: Bouhour
authors: Isabelle
authors: I
authors: Court-Fortune
authors: Jean-Philippe
authors: JP
authors: Camdessanche
authors: Jean-Christophe
authors: JC
authors: Antoine
authors: François
authors: F
authors: Philit
authors: Pascal
authors: P
authors: Beuret
authors: Sylvie
authors: S
authors: Bin-Dorel
authors: Christophe
authors: C
authors: Vial
authors: Emmanuel
authors: E
authors: Broussolle
mesh_terms: D000367:Age Factors; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063087:Noninvasive Ventilation; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D013183:Sputum / Q000378:metabolism*
keywords: airway secretion accumulation; amyotrophic lateral sclerosis; cohort studies; mechanically assisted cough; noninvasive ventilation tolerance; prognosis