A patient who has been diagnosed with ALS who has been attending your multidisciplinary clinic for..

A patient who has been diagnosed with ALS who has been
attending your multidisciplinary clinic for the last few years returns for a
follow-up visit. The patient states she has noticed her cough is not as
powerful as it has been and that she is “winded” when walking distances. The
respiratory therapist assesses the patient and finds: pulse rate of 80,
respiratory rate of 24, and breath sounds of scattered wet crackles in both
lungs. The patient performs spirometry and maximum inspiratory and expiratory
pressure maneuvers (MIP/MEP). Her FVC is 70% of predicted, MIP is negative 50
cm H2O and MEP is 55 cm H2O sitting, and MIP is negative 40 cm H2O
and MEP is 40 cm H2O supine. The therapist reviews the values from
the previous visit 3 months earlier and finds FVC was 75% of predicted and MIP
was a negative 65 cm H2O and the MEP was 70 cm H2O both
sitting and supine

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