I would like to bring to your attention about mucus plugs. It appears that in ALS the most common cause of sudden breathing difficulty is airway blockage due to mucus plug.
I have recently heard of several people dying due to sudden breathing difficulties caused by mucus plug blocking their airways. Sadly the cause (mucus plug ) had gone undetected and was not detected until after death. If it had been detected and treated they would still be alive today.
Weakened abdominal and throat muscles in ALS diminish the ability to cough. When a person with ALS can’t cough up mucus and inhaled particles, these can fall back into the lungs, where they can cause irritation and infection.
For those with a weak cough:
The simplest method is to place your hands or arms over the person’s stomach, just below the ribs and under the diaphragm, while he or she is lying down or sitting. After they take one or two deep breaths, firmly push in and upward toward the ribs as they cough. This will force air from the lungs more quickly and help push any secretions out through the mouth. Have a tissue or portable suction device available to collect any mucus coughed up.
This is best done on an empty stomach. If the person with ALS gets nauseous or throws up during the process, try gentler pushing. An increase or other change in mucus may indicate a respiratory infection needing medical attention.
NOTE: Let a respiratory therapist demonstrate these techniques so you’ll be sure to perform them correctly. If the person with ALS has any discomfort or bad reaction, consult the therapist or physician.
For mechanical assistance, the CoughAssist from Respironics, also called an insufflator-exsufflator, is a very handy, effective device. A mask is put over the mouth, and the machine blows air into the lungs, then reverses the flow, simulating a cough.
After either a manual or mechanical assisted cough, you may need to use a portable suction device to remove secretions from the mouth through a small tube. You can rent or buy a suction device (similar to those dentists use) from a medical equipment vendor or borrow one from the MDA loan closet.
Doctors also may suggest these cough assist methods:
Expectorants — prescription medications that thin secretions, making it easier to cough and clear the secretions
Breath stacking — closing the throat after each breath taken in through a mouthpiece and then coughing
Oscillation vests or airway clearance systems to “shake up” mucus in the chest
If you have sudden breathing problems seek medical attention asap, inform the Dr about possible mucus plug.