Benefit of Forced Expiratory Technique for Weak Cough in a Patient with Bulbar Onset Amyotrophic Lateral Sclerosis

The specific purpose of this case study was to investigate whether forced expiratory technique (FET) improves the peak expiratory flow compared to coughing in a 53-year-old man with amyotrophic lateral sclerosis (ALS) who presented with bulbar symptoms. Approximately 12 months after diagnosis, his peak cough flow did not exceed 160 L/min, and cough became ineffective. However, FET could generate peak expiratory flow to a point over the 160 L/min threshold until 14.5 months after diagnosis. As a result, FET delayed the need for tracheostomy. When the forced vital capacity (FVC) was observed to be markedly decreased and it was 1,600 mL, the patient was unable to achieve 160 L/min of peak expiratory flow generated by FET. Patients with bulbar onset ALS who have FVC greater than 1,600 mL may benefit