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More recently, home respiratory care has evolved to include portable home ventilators, airway clearance devices, and physiological assessments with telemonitoring capability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Current State of Respiratory Care<\/jats:title><jats:p>National organizations currently offer incentives for providing a pulmonary care specialist within a multidisciplinary ALS clinic; however, several critical gaps exist between the available technology and employing a clinician with the necessary expertise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Gaps in Care<\/jats:title><jats:p>Lack of formal training and poor financial incentives have led to a paucity of both clinicians and active clinical research engaging in the home respiratory care of ALS. Criteria for noninvasive ventilation (NIV) initiation are controversial, and few guidelines exist on the ideal subsequent adjustments of NIV with evolving disease. Consequently, many patients with ALS tolerate NIV poorly and must face the harrowing decision of hospice vs tracheostomy. Advancement of respiratory care in ALS has been hindered by critical gaps in pulmonologist availability, training in chronic respiratory failure, financial support, clinical research, and clarity on ventilation management beyond initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Bringing Respiratory Care Up to Speed<\/jats:title><jats:p>Only a multifaceted approach will suffice for addressing the voids in ALS respiratory care, including various education initiatives, financial incentives, clinical research programs, and elevating the standard of respiratory care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.27779","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T13:07:02Z","timestamp":1674133622000},"page":"341-353","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Pulmonary care for <scp>ALS<\/scp>: Progress, gaps, and paths forward"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4379-1255","authenticated-orcid":false,"given":"Jason","family":"Ackrivo","sequence":"first","affiliation":[{"name":"Pulmonary, Allergy, and Critical Care Division, Department of Medicine Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,19]]},"reference":[{"key":"e_1_2_12_2_1","first-page":"39","article-title":"Home care utilizing a ventilator in a patient with amyotrophic lateral sclerosis","volume":"10","author":"Lehner WE","year":"1980","journal-title":"J Fam Pract."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474\u20104422(05)70326\u20104"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20101331.2011.03501.x"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/24745332.2018.1559644"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resmer.2022.100901"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.2400"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awz280"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005053\u2010194710620\u201000003"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201702\u20100285ci"},{"key":"e_1_2_12_11_1","first-page":"42","article-title":"Pulmonary mechanical ventilation at home: a reasonable and less expensive alternative","volume":"28","author":"Sivak ED","year":"1983","journal-title":"Respir Care"},{"key":"e_1_2_12_12_1","first-page":"304","article-title":"Amyotrophic lateral sclerosis: a comprehensive rehabilitation approach","volume":"64","author":"Janiszewski DW","year":"1983","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102008\u20101041010"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-5231(21)00960-6"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000196308"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010127\u20106\u2010199709150\u201000006"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0022\u2010510x(99)00045\u20103"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(99)00228-2"},{"key":"e_1_2_12_19_1","unstructured":"Centers for Medicare & Medicaid Services. 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