{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T22:34:47Z","timestamp":1789425287712,"version":"build-2803163510"},"reference-count":21,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T00:00:00Z","timestamp":1656979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Effectiveness of mechanical assisted coughing with insufflation-exsufflation (MI-E) in amyotrophic lateral sclerosis (ALS) depends largely on severity of bulbar dysfunction, which can generate different upper-airway responses. The aim of the study was to evaluate the use of graphs generated by MI-E in ALS to detect airway obstruction and set parameters to achieve an effective mechanically assisted coughing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      This was a prospective study enrolling patients with ALS. Several sessions with MI-E were applied, administering different insufflation-exsufflation (\u00b1 20, \u00b1 30, \u00b1 40, \u00b1 50 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O) levels in each session. The graphs produced were recorded and analyzed, and the results were used to select the parameters resulting in more effective MI-E.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Sixty-nine subjects with ALS were included, yielding a total of 351 analyzed records. A pattern of obstruction during insufflation was detected in 34 subjects (50.7%) and of upper-airway collapse during exsufflation in 18 subjects (26%). The variable associated with obstruction during insufflation was bulbar upper motor neuron dysfunction (odds ratio 7.19 [95% CI 2.32\u201322.29],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001), whereas bulbar lower motor neuron dysfunction was related to upper-airway collapse during exsufflation (odds ratio 0.32 [95% CI 0.11\u20130.98],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .046). After parameters were adjusted, in 68 subjects (98.55%) an effective MI-E was achieved. The only variable that predicted absence of alterations in the graphs was Norris bulbar score (odds ratio 0.87 [95% CI 0.78\u20130.96],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Analysis of graphics generated by applying MI-E in ALS was an effective method to detect upper-airway responses and select optimal set parameters. Obstruction during insufflation is related to bulbar upper motor neuron dysfunction and collapse during exsufflation to bulbar lower motor neuron dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.09978","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T01:42:09Z","timestamp":1658972529000},"page":"1226-1235","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":27,"title":["Waveforms Analysis in Patients With Amyotrophic Lateral Sclerosis for Enhanced Efficacy of Mechanically Assisted Coughing"],"prefix":"10.1177","volume":"67","author":[{"given":"Jesus","family":"Sancho","sequence":"first","affiliation":[{"name":"Respiratory Medicine Department, Hospital Cl\u00ednico Universitario, Valencia, Spain; and INCLIVA Health Research Institute, Valencia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santos","family":"Ferrer","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, Hospital Cl\u00ednico Universitario, Valencia, Spain; and INCLIVA Health Research Institute, Valencia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enric","family":"Bures","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, Hospital Cl\u00ednico Universitario, Valencia, Spain; and INCLIVA Health Research Institute, Valencia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"Fernandez-Presa","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, Hospital Cl\u00ednico Universitario, Valencia, Spain; and INCLIVA Health Research Institute, Valencia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Ba\u00f1uls","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, Hospital Cl\u00ednico Universitario, Valencia, Spain; and INCLIVA Health Research Institute, Valencia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Cruz","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, Hospital Cl\u00ednico Universitario, Valencia, Spain; and INCLIVA Health Research Institute, Valencia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Signes-Costa","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, Hospital Cl\u00ednico Universitario, Valencia, Spain; and INCLIVA Health Research Institute, Valencia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,7,5]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.122.1.92"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2017.10.008"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PHM.0000137309.34404.BC"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2017.1335324"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.4.1400"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2015-207555"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2011.160481"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2019.06.012"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.4.2159"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/146608200300079536"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(99)00210-5"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.39.12.1635"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1183\/09041950.005s1693"},{"issue":"5","key":"e_1_3_2_15_2","first-page":"696","article-title":"Maximal respiratory pressures: normal values and relationship to age and sex","volume":"99","author":"Black LF","year":"1969","unstructured":"Black LF, , Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis, 1969; 99(5):696-702.","journal-title":"Am Rev Respir Dis"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.06.00121305"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200612-1841OC"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-200208000-00004"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2018.01.012"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06478"},{"key":"e_1_3_2_21_2","article-title":"Laryngospasm in amyotrophic lateral sclerosis","author":"Gotesman RD","year":"2021","unstructured":"Gotesman RD, , Lalonde E, , McKim DA, , Bourque PR, , Warman-Chardon J, , Zwicker J, , Breiner A. Laryngospasm in amyotrophic lateral sclerosis. Muscle Nerve. 2021. [Epub ahead of print]. doi: 10.1002\/mus.27466.","journal-title":"Muscle Nerve"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1998.84.3.1076"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.4187\/respcare.09978","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.09978","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.09978","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T09:13:55Z","timestamp":1775466835000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4187\/respcare.09978"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,5]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.4187\/respcare.09978"],"URL":"https:\/\/doi.org\/10.4187\/respcare.09978","relation":{},"ISSN":["0020-1324"],"issn-type":[{"value":"0020-1324","type":"print"}],"subject":[],"published":{"date-parts":[[2022,7,5]]}}}