Tracheostomy tubes are not needed for Duchenne muscular dystrophy

To the Editors: Respiratory failure is the main cause of death in patients with Duchenne muscular dystrophy (DMD). Some respiratory management paradigms recommend tracheostomy for ventilator-dependent DMD patients. Prolongation of survival by years and, in many cases, decades using continuous mechanical noninvasive ventilation (NIV) without tracheostomy has been reported 1. Toussaint et al. 2 reported their experience on the use of NIV along with assisted coughing to prolong life and avoid tracheostomy for patients with DMD. However, the commentary by Lofaso et al. 3 on this outstanding work was uninformed. The commentators failed to present the outcomes of continuous NIV from other centres 4–6 and they have, apparently, no experience in continuous long-term NIV. These authors seem to be unaware that more than 250 long-term (mostly 24-h dependent) NIV users whose main interface was a simple mouthpiece during the day and a mouthpiece with a plastic phalange during sleep have …