Why does ALS make it harder to swallow and cough? 

Typically, when a person swallows, materials like food, liquids, and saliva go from the mouth to the back of the throat and down into the esophagus. The tongue and the muscles in the throat work together to make this process happen. The tongue also moves saliva around to prevent any part of the mouth from getting dry.

ALS can weaken the muscles of the tongue and throat. This makes it harder for your body to move food, liquids, and saliva where they need to go. As a result, these materials can pass into your lungs by mistake, and you become more likely to aspirate (choke). Additionally, when your tongue can’t move saliva around inside your mouth, the top of your mouth gets dry. At the same time, if you have a lot of saliva sitting inside your mouth, your mouth may not feel dry — in fact, it may feel too wet.

Weaker muscles also make it harder for people living with ALS to cough. Over time, some people living with ALS lose the ability to cough completely. This is important because coughing helps us clear out our lungs and get rid of anything that shouldn’t be there (including materials like pieces of food, liquids, or saliva). All these changes increase your risk of getting sick with pneumonia.

To help keep your lungs clear, your ALS care team may recommend taking medicine, using a cough device, or suctioning your lungs with an airway cleaning device. While these treatments can help you feel better for a while, they cannot stop ALS from progressing (getting worse).