Monday, March 25, 2013

Secretion Management in ALS

Some people with ALS will have difficulty with what feels like excess saliva in their mouths, which may result in drooling (sialorrhea), choking and disrupted sleep.

Saliva is a normal substance in our bodies, used to help moisten the oral cavity (our mouths and throats) so that we can swallow more easily. It also plays a role in early digestion of our food. Saliva production is increased anytime we smell, taste, chew and swallow food. For the person with ALS who has weakened mouth, tongue and throat muscles, swallowing normally-occurring saliva can be difficult, resulting in drooling and/or choking. Medications commonly prescribed to decrease saliva include: amitriptyline, robinol ®, levsin ® and Scopolamine® patches. Possible side effects of these medications include dry mouth, constipation, and urinary hesitancy. These drugs should be used with caution if you have glaucoma, an enlarged prostate or problems with memory loss. Botox® (botulinum toxin) is often prescribed if the medications noted above, are ineffective. Botox is injected (by a physician who has received special training in this area) directly into the parotid and submandibular glands, where the saliva is made, causing a decrease in saliva production. It often takes 1-2 weeks for maximum effectiveness, and if it is successful, will usually last (decrease saliva production) up to 12 weeks.

For sleeping difficulties due to the build-up of saliva, try elevating the head of the bed with pillows or by placing a bed wedge under the mattress.

Thick sputum in the back of the throat can be another concern for the person with ALS who has weakened throat muscles. Clearing sputum can be difficult, often leading to choking and/or the fear of choking. Medications used to treat this problem include: Guaifenesin (which is plain Robitussin®), Albuterol® and Mucomist®. The latter two medications are usually administered via a Nebulizer; a Nebulizer is a machine that changes the liquid Albuterol® and/or Mucomist® into a mist, which is then inhaled via a mask.

Two other pieces of respiratory equipment may be helpful in battling thick phlegm—the suction machine and the cough-assist device. The suction machine may help in loosening and clearing sputum by placing a large catheter, or wand (called a yankeur catheter), in the front part of the throat. This both stimulates a cough reflex and some of the sputum will be suctioned out via the wand. The cough-assist machine produces a pressure that helps the person with weakened throat and mouth muscles produce a stronger, more effective cough. The Nebulizer, suction machine and cough assist device are usually covered under most health insurance policies. A respiratory therapist (RT) should be involved in teaching how to use the respiratory equipment properly.

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