Noninvasive Ventilation in ALS Patients With Mild Respiratory Involvement

Study Overview
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Brief Summary
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Non-invasive ventilation or BiPAP®, which is a form of breathing support delivered through a facemask, is a successful treatment for the respiratory complications of amyotrophic lateral sclerosis (ALS). It has been shown to prolong survival, improve quality of life, and improve cognitive function. It is widely used among patients with ALS who have advanced breathing difficulties. It is not known whether there is benefit to using non-invasive ventilation earlier in the disease course. There is evidence that non-invasive ventilation may slow down the decline in breathing function. If this were true then it would make sense to start non-invasive ventilation use earlier than the current clinically accepted practices. The purpose of this study is to determine whether using non-invasive ventilation early in the course of disease can slow the decline in breathing function. Patients remain in the study for 6 months and are asked to make 7 clinic visits during which time they will undergo pulmonary function tests and complete questionnaires.

Detailed Description
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This is a randomized, crossover trial for patient with ALS and mild respiratory involvement. Patients with forced vital capacity above 60% of the predicted value can join. Patients will be assigned to either start using non-invasive ventilation at night or continue their usual care. After three months, patients will switch over to the other treatment group. For example, a patient who was initially assigned to continue their usual care would begin using non-invasive ventilation after three months.

Official Title
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Noninvasive Ventilation in ALS Patients With Mild Respiratory Involvement

Conditions
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Amyotrophic Lateral Sclerosis

Intervention / Treatment
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* Device: noninvasive positive pressure ventilation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Probable or definite ALS by El Escorial criteria age >17 years FVC >60 minimal respiratory symptoms (no orthopnea or dyspnea at rest) ability to provide informed consent Exclusion Criteria: Presence of another neurodegenerative disease arterial CO2 above 45 mmHg O2 below 60 mmHg coexisting chronic lung disease unrelated to ALS presence of an unstable medical condition such as coronary artery disease, liver failure, renal failure or cancer in the 30 days preceding enrollment

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: noninvasive positive pressure ventilation|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Decline in forced vital capacity |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| quality of life |  |  | 
| respiratory quality of life |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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bipap, lou gehrigs disease, motor neuron disease, respiratory muscles