Iliana Howard
Dr. Ileana Howard, MD, is an ALS physiatrist and Professor of Rehabilitation Medicine at the University of Washington, and Medical Co-Director of the ALS Center of Excellence at VA Puget Sound in Seattle.
1
APPEARANCES
1
PODCASTS
Sep 16, 2026
MikeHOST
So when should respiratory support like cough assist or non-invasive ventilation begin?
Iliana HowardGUEST
So breathing depends on muscles, um, just like all of the other movement in our body.
Iliana HowardGUEST
And unfortunately, because ALS impacts the motor neurons, it often will significantly impact breathing as well as ability to clear secretions and keep our lungs healthy.
Iliana HowardGUEST
Uh, very early on, even at the time of diagnosis, we'll find that, uh, the diaphragm has been in- impacted and is significantly weak.
Iliana HowardGUEST
Therefore, we have to treat breathing, um, and the thought of, of rehabilitating, um, the muscles of breathing the same as we do for the rest of the body.
Iliana HowardGUEST
Um, uh, non-invasive ventilation with, uh, a BiPAP, um, is standard of care in ALS.
5 MINS LATER
MikeHOST
[laughs]