The importance of a respiratory therapist in the ALS clinic

Although multidisciplinary amyotrophic lateral sclerosis (ALS) clinics are widely endorsed, there is limited evidence they improve outcome. We retrospectively assessed use of non-invasive ventilation in 37 ALS patients seen before and 40 patients seen after the addition of a respiratory therapist to our clinic. Patients undergoing respiratory therapy were more likely to try non-invasive ventilation (odds ratio 4.01; 95% confidence interval 1.42-11.35) and more likely to use it for at least four hours per night (odds ratio 9.5, 95% confidence interval 2.32-38.88). Median survival following non-invasive ventilation institution was 10 months for those using it four or more hours per night and five months for those who refused it or who used it for less than four hours per night (p < 0.03). We conclude that adding a respiratory therapist to our multidisciplinary ALS clinic led to an increase in the percentage of patients willing to try BiNIV as well as to use it more than four hours per night, and confirm as in prior studies that such use leads to prolonged survival.