Can a daily breathing exercise slow ALS lung decline?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. Provision of signed and dated informed consent form. 2. Stated willingness to comply with all study procedures and availability for the duration of the study. 3. Age ≥18 years. 4. Diagnosed with amyotrophic lateral sclerosis using the Gold Coast Criteria. 5. Have an able and willing caregiver to assist with mechanical insufflation on a daily basis. 6. Willingness and ability to participate in study procedures. Exclusion Criteria: 1. Age \<18 years old. 2. Inability to perform a cough peak flow or spirometry manuever 3. Current use of non-invasive ventilation (NIV), bi-level positive pressure ventilation, or "Bi-PAP" or physician prescribing NIV on day of potential enrollment. 4. 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. 5. Active enrollment in hospice. 6. Current tracheostomy. 7. Presence of cognitive dysfunction that would impair ability to complete study procedures, as determined by neurology attending physician. 8. Absence of an able and willing caregiver to assist with MI twice daily as specified in the protocol. 9. Pregnancy 10. Medical history of any of the following: 1. Recent hemoptysis 2. Recent barotrauma 3. History of emphysema of any kind (including bullous emphysema) 4. History of or known susceptibility to pneumothorax 5. History of or known susceptibility to pneumomediastinum 6. Chronic obstructive pulmonary disease 7. Uncontrolled asthma (defined as recent exacerbation requiring corticosteroids in the previous 30 days) 8. Symptomatic cardiomyopathy (heart failure) with left ventricular ejection fraction less than 50% 9. History of right heart failure or pulmonary hypertension 11. Current smoker or tobacco use within the last 30 days.