The use of traditional pulmonary function tests particularly FVC (forced vital capacity) and SVC (slow vital capacity) has been a central to both the clinical care of patients with Amyotrophic Lateral Sclerosis and the assessment of new therapeutics for patients with ALS. Most recently, the use of the respiratory component of the ALSFRS-R has come into question in drug development programs. Additionally the use of these pulmonary function measures also disadvantage patients with bulbar onset ALS.
The COVID 19 pandemic has led to fundamental changes in ALS clinical care, and in clinical trial execution. As part of the process of rethinking respiratory function assessment, the teams whose manuscripts are contained in this supplement, have investigated and validated a number of alternatives including the option of a predictive algorithm that excludes respiratory function. Dr Rudnicki's editorial provides a review and critical perspective on how these measures can be integrated into the most innovative development programs moving forward.
I invite all members of the ALS community to consider the techniques in this supplement in current future ALS programs to both improve care, decrease risk to health care providers and to allow more precise assessment of pulmonary function changes over time in drug development programs
Sincerely
Angela Genge, MD, FRCP(C)