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Secretion Management in ALS
Some ALS patients 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 ALS patient who
has weakened mouth, tongue and throat muscles, swallowing normallyoccurring 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.
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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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