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Amyotrophic Lateral SclerosisMI-PALSNCT06119087

Mechanical Insufflation in the Philadelphia Amyotrophic Lateral Sclerosis Cohort (MI-PALS) Study

A study testing Mechanical insufflation in people with Amyotrophic Lateral Sclerosis and Chronic Respiratory Failure, run by University of Pennsylvania at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this clinical trial is to learn how doing mechanical insufflation (MI) using a mechanical insufflator-exsufflator (MI-E) device affects breathing in early amyotrophic lateral sclerosis (ALS). This will be a single-center, single-arm study of MI in 20 patients with ALS at Penn. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Mechanical insufflation
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
23 participants
Where
1 siteUnited States
Study dates
12 Sep 2024to 30 Jul 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Provision of signed and dated informed consent form.
  • Stated willingness to comply with all study procedures and availability for the duration of the study.
  • Age ≥18 years.
  • Diagnosed with amyotrophic lateral sclerosis using the Gold Coast Criteria.
  • Have an able and willing caregiver to assist with mechanical insufflation on a daily basis.
  • Willingness and ability to participate in study procedures.

Who cannot join

  • Age <18 years old.
  • Inability to perform a cough peak flow or spirometry manuever
  • Current use of non-invasive ventilation (NIV), bi-level positive pressure ventilation, or "Bi-PAP" or physician prescribing NIV on day of potential enrollment.
  • Current use of MI-E (also known as a "cough assist device") for airway clearance. Please note that patients can start use of a MI-E device subsequent to enrollment while currently being followed for the study.
  • Active enrollment in hospice.
  • Current tracheostomy.
Show all 20Show fewer
  • Presence of cognitive dysfunction that would impair ability to complete study procedures, as determined by neurology attending physician.
  • Absence of an able and willing caregiver to assist with MI twice daily as specified in the protocol.
  • Pregnancy
  • Medical history of any of the following:
  • Recent hemoptysis
  • Recent barotrauma
  • History of emphysema of any kind (including bullous emphysema)
  • History of or known susceptibility to pneumothorax
  • History of or known susceptibility to pneumomediastinum
  • Chronic obstructive pulmonary disease
  • Uncontrolled asthma (defined as recent exacerbation requiring corticosteroids in the previous 30 days)
  • Symptomatic cardiomyopathy (heart failure) with left ventricular ejection fraction less than 50%
  • History of right heart failure or pulmonary hypertension
  • Current smoker or tobacco use within the last 30 days.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

Other trials in United States

About this study

The goal of this clinical trial is to learn how doing mechanical insufflation (MI) using a mechanical insufflator-exsufflator (MI-E) device affects breathing in early amyotrophic lateral sclerosis (ALS). This will be a single-center, single-arm study of MI in 20 patients with ALS at Penn.

Based on prior research, we believe that 6-months of MI may slow decline in cough strength, measured as peak cough flow (PCF).

Read more

Participants will perform MI using a device designed for mechanical insufflation-exsufflation (MI-E) known as the BiWaze Cough system. The BiWaze Cough is used for mucus clearance . It is connected to tubing and mouthpiece (or mask). The device will use programmed pressure and timing settings. An insufflation includes inflating the lungs for a maximal size inhalation before exhaling. The daily routine for the device includes 5 sets of 5 insufflations twice daily.

Researchers will compare how use of MI in early ALS affects peak cough flow compared to 20 subjects who did not use MI in early ALS.

Being tested
Mechanical insufflation
Keywords
amyotrophic lateral sclerosis, chronic respiratory failure, neuromuscular weakness, mechanical insufflation-exsufflation, peak cough flow
Medical subject headings
Amyotrophic Lateral Sclerosis, Neuromuscular Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Mechanical insufflationDevice

    Mechanical insufflation (MI) is a chest physiotherapy exercise that will be performed using a type of mechanical insufflator-exsufflator (MI-E) known as the BiWaze Cough device. The device connects to a tube that can interface with a patient using either a facemask or mouthpiece.

    Mechanical insufflation is a chest physiotherapy exercise that passively inflates the chest with positive pressure that is delivered in coordination with the patient's own inspiratory timing until maximal inflation capacity (MIC), determined by the patient or maximal chest rise on visual inspection. At MIC, the patient passively exhales, which completes one "cycle". Prior literature has used a "dose" of 5 sets of 5 cycles once or twice daily. The maneuver is usually performed with assistance of a caregiver to hold the mask or mouthpiece in place.

Study groups in NCT06119087
Study groupRoleWhat they receive
Mechanical insufflationExperimentalParticipants will be asked to perform mechanical insufflation using the BiWaze cough device as 5 sets of 5 insufflations twice daily for 6 months.
Receives: Device: Mechanical insufflation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. peak cough flow (PCF)

    PCF in liters/minute as measured by use of a peak flow meter while the patient is in a seated upright position. An alternative device for measuring PCF can be the use of a handheld spirometer and using the measured peak expiratory flow by multiplying by 60 to convert from liters/second to liters/minute.

    The subject must be seated in an upright position and the interface must include a mouthpiece or an oronasal mask. Subjects are asked to perform a deep inhalation followed by a maximal cough.

    Measured: 6 months

Secondary outcomes (9)
  1. Forced vital capacity (FVC)

    Defined as maximal volume, in liters, that a person can exhale forcefully after a complete inhalation.

    Measured using a spirometer connected to a face mask or mouthpiece in the sitting and upright position.

    Measured: 6 months

  2. Maximal inspiratory pressure (MIP)

    Defined as the maximum pressure, in cmH2O, generated when the subject exhales as much air as possible and then immediately inhales as forcefully as possible.

    Measured: 6 months

  3. Maximal expiratory pressure (MEP)

    Defined as the maximum pressure, in cmH2O, generated when the subject inhales as much air as possible and then immediately exhales as forcefully as possible.

    Measured using a hand-held manual or digital manometer connected to a mouthpiece or mask in the sitting and upright position.

    Measured: 6 months

  4. Maximum insufflation capacity (MIC)

    Defined as exhaled volume, in liters, immediately following a MI maneuver to maximum insufflation capacity.

    Measured using a spirometer connected to a face mask or mouthpiece, in the sitting and upright position.

    Measured: 6 months

  5. Maximum insufflation capacity assisted peak cough flow

    Defined as the peak cough flow generated from MIC.

    Lungs are inflated to MIC using MI and before the subject exhales they insert a peak flow meter in their mouth and follow with a peak cough flow as described above.

    Measured: 6 months

  6. MIC-FVC difference

    defined by subtracting the FVC from the MIC

    Measured: 6 months

  7. Transcutaneous carbon dioxide

    Defined as the average value in mmHg from a daytime in-clinic measurement over a 15-minute transcutaneous recording.

    Measured using a Sentec transcutaneous digital monitoring system while the subject is sitting upright in a chair or wheelchair. The transcutaneous sensor can be placed on the subject forehead, cheek, or earlobe.

    Measured: 6 months

  8. ALS Functional Rating Scale - Revised (ALSFRS-R) dyspnea and orthopnea scores

    The ALSFRS-R is a 12-item standardized questionnaire to assess the motor function status of an individual with ALS. The ALSFRS-R is assessed by a research staff member who has been certified for performance of the ALSFRS-R.

    The dyspnea score is one of the questions focusing on level of shortness of breath, scored on a scale of 0 to 4, with 4 being no symptoms at all and 0 being severely symptomatic with consideration of mechanical respiratory support.

    The orthopnea score is one of the questions focused on breathing symptoms and difficulty sleeping while lying supine, scored on a scale of 0 to 4, with 4 being no symptoms at all and 0 being severely symptomatic with inability to sleep.

    Measured: 6 months

  9. Global rate of change score for peak cough flow

    The global rate of change score for the peak cough flow will ask patients how effective they think their cough is today by rating it on a Likert scale from -7 (extremely impaired) to +7 (extremely strong).

    Measured: 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Nov 2023
  2. Study start12 Sep 2024
  3. Primary completion30 Jul 2026
  4. Study completion30 Jul 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Not applicable
Intervention model
Single group
Model description
single-center, single-arm feasibility pilot study of in 20 patients with ALS.
Masking
None (open label)
Enrolment
23 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06119087
Sponsor's protocol ID
854981
Acronym
MI-PALS
Status last verified
Aug 2026
First submitted
31 Oct 2023
Last updated
12 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Kaminska M, Browman F, Trojan DA, Genge A, Benedetti A, Petrof BJ. Feasibility of Lung Volume Recruitment in Early Neuromuscular Weakness: A Comparison Between Amyotrophic Lateral Sclerosis, Myotonic Dystrophy, and Postpolio Syndrome. PM R. 2015 Jul;7(7):677-684. doi: 10.1016/j.pmrj.2015.04.001. Epub 2015 Apr 3.

    PubMed 25845857
  • Katz SL, Barrowman N, Monsour A, Su S, Hoey L, McKim D. Long-Term Effects of Lung Volume Recruitment on Maximal Inspiratory Capacity and Vital Capacity in Duchenne Muscular Dystrophy. Ann Am Thorac Soc. 2016 Feb;13(2):217-22. doi: 10.1513/AnnalsATS.201507-475BC.

    PubMed 26599476
  • McKim DA, Katz SL, Barrowman N, Ni A, LeBlanc C. Lung volume recruitment slows pulmonary function decline in Duchenne muscular dystrophy. Arch Phys Med Rehabil. 2012 Jul;93(7):1117-22. doi: 10.1016/j.apmr.2012.02.024. Epub 2012 Mar 12.

    PubMed 22421625
  • Chiou M, Bach JR, Jethani L, Gallagher MF. Active lung volume recruitment to preserve vital capacity in Duchenne muscular dystrophy. J Rehabil Med. 2017 Jan 19;49(1):49-53. doi: 10.2340/16501977-2144.

    PubMed 27630091
  • Mustfa N, Aiello M, Lyall RA, Nikoletou D, Olivieri D, Leigh PN, Davidson AC, Polkey MI, Moxham J. Cough augmentation in amyotrophic lateral sclerosis. Neurology. 2003 Nov 11;61(9):1285-7. doi: 10.1212/01.wnl.0000092018.56823.02.

    PubMed 14610141
  • Chatwin M, Bush A, Simonds AK. Outcome of goal-directed non-invasive ventilation and mechanical insufflation/exsufflation in spinal muscular atrophy type I. Arch Dis Child. 2011 May;96(5):426-32. doi: 10.1136/adc.2009.177832. Epub 2010 Jun 23.

    PubMed 20573738
  • Vianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, Bevilacqua M. Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections. Am J Phys Med Rehabil. 2005 Feb;84(2):83-8; discussion 89-91. doi: 10.1097/01.phm.0000151941.97266.96.

    PubMed 15668554
  • Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004 Apr;125(4):1406-12. doi: 10.1378/chest.125.4.1406.

    PubMed 15078753
  • Tzeng AC, Bach JR. Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest. 2000 Nov;118(5):1390-6. doi: 10.1378/chest.118.5.1390.

    PubMed 11083691
  • Bach JR, Goncalves MR, Hamdani I, Winck JC. Extubation of patients with neuromuscular weakness: a new management paradigm. Chest. 2010 May;137(5):1033-9. doi: 10.1378/chest.09-2144. Epub 2009 Dec 29.

    PubMed 20040608
  • Vitacca M, Paneroni M, Trainini D, Bianchi L, Assoni G, Saleri M, Gile S, Winck JC, Goncalves MR. At home and on demand mechanical cough assistance program for patients with amyotrophic lateral sclerosis. Am J Phys Med Rehabil. 2010 May;89(5):401-6. doi: 10.1097/PHM.0b013e3181d89760.

    PubMed 20407305
  • Chatwin M, Toussaint M, Goncalves MR, Sheers N, Mellies U, Gonzales-Bermejo J, Sancho J, Fauroux B, Andersen T, Hov B, Nygren-Bonnier M, Lacombe M, Pernet K, Kampelmacher M, Devaux C, Kinnett K, Sheehan D, Rao F, Villanova M, Berlowitz D, Morrow BM. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med. 2018 Mar;136:98-110. doi: 10.1016/j.rmed.2018.01.012. Epub 2018 Feb 6.

    PubMed 29501255
  • Miller RG, Jackson CE, Kasarskis EJ, England JD, Forshew D, Johnston W, Kalra S, Katz JS, Mitsumoto H, Rosenfeld J, Shoesmith C, Strong MJ, Woolley SC; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009 Oct 13;73(15):1218-26. doi: 10.1212/WNL.0b013e3181bc0141.

    PubMed 19822872
  • Sawnani H, Mayer OH, Modi AC, Pascoe JE, McConnell K, McDonough JM, Rutkowski AM, Hossain MM, Szczesniak R, Tadesse DG, Schuler CL, Amin R. Randomized trial of lung hyperinflation therapy in children with congenital muscular dystrophy. Pediatr Pulmonol. 2020 Sep;55(9):2471-2478. doi: 10.1002/ppul.24954. Epub 2020 Jul 20.

    PubMed 32658385
  • McDonald LA, Berlowitz DJ, Howard ME, Rautela L, Chao C, Sheers N. Pneumothorax in neuromuscular disease associated with lung volume recruitment and mechanical insufflation-exsufflation. Respirol Case Rep. 2019 Jun 13;7(6):e00447. doi: 10.1002/rcr2.447. eCollection 2019 Aug.

    PubMed 31210952

Questions about this trial

What is this clinical trial studying?

A study testing Mechanical insufflation in people with Amyotrophic Lateral Sclerosis and Chronic Respiratory Failure, run by University of Pennsylvania at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

peak cough flow (PCF) (time frame: 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06119087, which also lists 32 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Aug 2026.

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