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OLD DEVICE OFFERS NEW HOPE FOR LUNG PATIENTS

Brad Smith was turned into a speechless invalid overnight when his doctor drilled a hole in his throat to pump air into his disease-weakened lungs.

His doctor didn't know there was an alternative. Now a New Jersey physician is out to change that, sewing up patients' tracheas and helping them breathe again with a simple polio-era machine unearthed from a museum."A week ago, I couldn't breathe on my own for five minutes, and today I've been fine for five hours and back at work," said Smith, a State Department terrorism specialist with Lou Gehrig's disease. "People like me are being put through a chamber of horrors and there's no need."

Neuromuscular diseases such as Lou Gehrig's, muscular dystrophy or paralysis weaken chest muscles until victims can no longer breathe easily or cough to clear their lungs of dangerous mucus.

Typically, these patients get a tracheotomy - a tube inserted through a hole drilled in the throat so air can be pumped in and secretions suctioned out. The opening is vulnerable to lethal bacteria and patients routinely get pneumonia. Often, they can't speak. Constant care to keep the tubes open forces many into nursing homes.

There is a non-invasive alternative that few doctors offer, contends Dr. John Bach of the University of Medicine and Dentistry of New Jersey. Key is a 1952 machine called the Cof-flator that, when held to the mouth, sucks air from the bronchial tubes to induce a cough that patients can't force unaided.

Not every patient qualifies, cautioned Dr. Norma Braun, an American Lung Association specialist who also practices non-invasive respiratory care at Columbia University. Some are just too weak or don't do the techniques properly - and it's not a cure for these ever-worsening diseases.

"When it's effective, it's wonderful," she said. "When it's not effective, it's a disaster."

Ventilators that send continuous oxygen through the nose or mouth became popular in the 1970s, but didn't help many neuromuscular patients because they didn't solve the coughing problem.