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BiWaze Cough System: Revolutionizing ALS Management through Cough Assist

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Amyotrophic Lateral Sclerosis (ALS) is a relentless neurodegenerative disease that impacts nerve cells in the brain and spinal cord. As the disease progresses, patients grapple with respiratory muscle weakness and secretions, making their management a critical aspect of ALS care. A key player in this battle is the cough assist device. This article delves into the world of cough assist, with a special focus on the innovative BiWaze Cough System and its role in ALS management.

The Role of Cough Assist in ALS Management

A cough assist device, also known as a mechanical insufflator-exsufflator, is a machine designed to clear secretions from the lungs. It operates by delivering a deep mechanical breath (insufflation) followed by a sudden shift to negative pressure (exsufflation), simulating a high-flow cough. This process is crucial in ALS management, as it aids in secretion management, reducing the risk of pulmonary infections and hospitalization rates.

BiWaze Cough System: A Breakthrough in ALS Management

The BiWaze Cough System from ABM Respiratory Care is a non-invasive solution that enhances airway clearance by simulating a cough to clear mucus from the patient’s lungs. It offers an intuitive setup, greater connectivity, and cleaner care. Unlike other airway clearance systems that use one pathway for inhaling air and exhaling mucus, the BiWaze Cough changes that dynamic with dual air pathways separated for inhale and exhale flows. This helps ensure the inhaled air is not contaminated with mucus from the exhaled air, making it a game-changer in ALS management.

Boy doing cough assist therapy with BiWaze Cough

The Application of BiWaze in ALS Management

The BiWaze Cough System combines multiple therapies of assisted cough and lung expansion along with high-frequency oscillation. It breaks up and then removes mucus from the lungs by applying positive air pressure (inhale) to the airway and then rapidly shifting to negative air pressure (exhale). After exhale, the pause phase allows the user to rest before the next assisted cough cycle. BiWaze Cough can provide positive pressure flow during the pause phase so the person’s airways are stinted open after the exhale instead of being forcefully reopened with the next inhale.

The system provides a non-invasive solution to enhance airway clearance, which is essential to avoid retained mucus that causes infection, inflammation, and respiratory failure. Each therapy cycle can be personalized to provide the most effective therapy for a person’s respiratory condition.

Combining Cough Assist with Other Techniques in ALS Management

In cases where secretions are large or tough and cannot be fully expectorated, cough assist can be combined with other techniques. High-frequency chest wall oscillation (HFCWO) or intermittently applied intrapulmonary percussive ventilation (IPV) can be used to improve mucociliary clearance and transport secretions from the lung periphery to the large airways. From there, the cough assist device, such as the BiWaze Cough System, can be used to remove the secretions.


The application of cough assist in ALS management, particularly with the use of innovative devices like the BiWaze Cough System, is a testament to the power of modern medical technology. By helping clear secretions from the lungs, these devices can significantly improve the quality of life for ALS patients. As we continue to battle this challenging disease, tools like the BiWaze Cough System will remain at the forefront of symptom management and patient care.


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