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A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis

A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis
A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis
Failure to clear oral secretions can be debilitating for patients with amyotrophic lateral sclerosis (ALS), but the treatment of this symptom is poorly defined and there is no consensus on best practice. The objective of this study was to identify the treatments that are commonly prescribed, and to describe how experienced clinicians manage a patient with treatment resistant symptoms. Twenty-three clinicians were approached, of which 19 from 16 centres across the UK provided case report forms for a total of 119 ALS patients identified as having problematic oral secretions. The use of five anticholinergics, salivary gland botulinum toxin injections, conservative management approaches and carbocisteine were reported. Of the 72 patients who were evaluated following the initiation of a first anticholinergic, 61% had symptomatic improvement. Only 19% of patients achieved symptomatic improvement with the use of an alternative anticholinergic when an initial anticholinergic achieved no symptomatic improvement. Problems with thick and thin secretions often coexisted, with 37% of patients receiving treatment for both types of problem. In conclusion, a variety of treatment options are employed by expert clinicians for problematic oral secretions in ALS patients. The variation in management highlights the need for further prospective research in this area.
2167-8421
1-9
McGeachan, Alexander J.
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Hobson, Esther V.
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Al-Chalabi, Ammar
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Stephenson, Jodie
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Chandran, Siddharthan
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Crawley, Francesca
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Dick, David
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Donaghy, Colette
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Ellis, Cathy M.
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Gorrie, George
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Hanemann, C. Oliver
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Harrower, Timothy
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Jung, Agam
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Malaspina, Andrea
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Morrison, Karen E.
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Orrell, Richard W.
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Talbot, Kevin
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Turner, Martin R.
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Williams, Timothy L.
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Young, Carolyn A.
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Shaw, Pamela J.
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McDermott, Christopher J.
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McGeachan, Alexander J.
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Hobson, Esther V.
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Al-Chalabi, Ammar
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Stephenson, Jodie
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Chandran, Siddharthan
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Crawley, Francesca
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Dick, David
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Donaghy, Colette
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Ellis, Cathy M.
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Gorrie, George
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Hanemann, C. Oliver
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Harrower, Timothy
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Jung, Agam
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Malaspina, Andrea
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Morrison, Karen E.
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Orrell, Richard W.
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Talbot, Kevin
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Turner, Martin R.
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Williams, Timothy L.
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Young, Carolyn A.
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Shaw, Pamela J.
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McDermott, Christopher J.
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McGeachan, Alexander J., Hobson, Esther V., Al-Chalabi, Ammar, Stephenson, Jodie, Chandran, Siddharthan, Crawley, Francesca, Dick, David, Donaghy, Colette, Ellis, Cathy M., Gorrie, George, Hanemann, C. Oliver, Harrower, Timothy, Jung, Agam, Malaspina, Andrea, Morrison, Karen E., Orrell, Richard W., Talbot, Kevin, Turner, Martin R., Williams, Timothy L., Young, Carolyn A., Shaw, Pamela J. and McDermott, Christopher J. (2016) A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 1-9. (doi:10.1080/21678421.2016.1221433).

Record type: Article

Abstract

Failure to clear oral secretions can be debilitating for patients with amyotrophic lateral sclerosis (ALS), but the treatment of this symptom is poorly defined and there is no consensus on best practice. The objective of this study was to identify the treatments that are commonly prescribed, and to describe how experienced clinicians manage a patient with treatment resistant symptoms. Twenty-three clinicians were approached, of which 19 from 16 centres across the UK provided case report forms for a total of 119 ALS patients identified as having problematic oral secretions. The use of five anticholinergics, salivary gland botulinum toxin injections, conservative management approaches and carbocisteine were reported. Of the 72 patients who were evaluated following the initiation of a first anticholinergic, 61% had symptomatic improvement. Only 19% of patients achieved symptomatic improvement with the use of an alternative anticholinergic when an initial anticholinergic achieved no symptomatic improvement. Problems with thick and thin secretions often coexisted, with 37% of patients receiving treatment for both types of problem. In conclusion, a variety of treatment options are employed by expert clinicians for problematic oral secretions in ALS patients. The variation in management highlights the need for further prospective research in this area.

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More information

Accepted/In Press date: 1 August 2016
e-pub ahead of print date: 31 August 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 402880
URI: http://eprints.soton.ac.uk/id/eprint/402880
ISSN: 2167-8421
PURE UUID: 423c22de-634e-41ff-89ed-5dfde65ff8e5
ORCID for Karen E. Morrison: ORCID iD orcid.org/0000-0003-0216-5717

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Date deposited: 15 Nov 2016 09:25
Last modified: 07 Oct 2020 02:09

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Contributors

Author: Alexander J. McGeachan
Author: Esther V. Hobson
Author: Ammar Al-Chalabi
Author: Jodie Stephenson
Author: Siddharthan Chandran
Author: Francesca Crawley
Author: David Dick
Author: Colette Donaghy
Author: Cathy M. Ellis
Author: George Gorrie
Author: C. Oliver Hanemann
Author: Timothy Harrower
Author: Agam Jung
Author: Andrea Malaspina
Author: Karen E. Morrison ORCID iD
Author: Richard W. Orrell
Author: Kevin Talbot
Author: Martin R. Turner
Author: Timothy L. Williams
Author: Carolyn A. Young
Author: Pamela J. Shaw
Author: Christopher J. McDermott

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