A 50-year-old man with ALS is admitted to the hospital because of right lower lobe pneumonia. The…

A 50-year-old man with ALS is admitted to the hospital
because of right lower lobe pneumonia. The patient is moderately hypoxemic,
with PO2 of 68 mm Hg on room air. ALS was diagnosed 3 years previously, and he
has had progressive worsening of dyspnea since then. These symptoms first
occurred with mild exertion and then with supine position, which the patient
has noticed in the last 1 or 2 months. A recent measurement of VC at the
physician’s office was 35 ml/kg. The patient has recent noticed difficulty with
swallowing and frequent coughing at meals. What features in the patient’s history
may be relevant with regard to management?

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