To a considerable extent, the success of mechanically assisted coughing with insufflation-exsufflation (MI-E) in amyotrophic lateral sclerosis (ALS) is determined by the severity of bulbar dysfunction, which in turn can produce various upper-airway responses. The study’s overarching objective was to assess how well MI-graphs E’s might be used to detect airway obstruction and optimize mechanically assisted coughing in ALS patients. Patients with ALS were enrolled in a future trial. Multiple MI-E sessions were performed, each with a unique insufflation-exsufflation level (± 20, ± 30, ± 40, and ± 50 cm H2O). All of the generated graphs were saved for later review, and the data from that analysis was utilized to fine-tune MI-settings. E’s There were 69 people diagnosed with ALS, and their records were combined to make 351 sets of data. It was shown that 34 participants (50.70%) had a pattern of obstruction during insufflation, while 18 subjects (26.6%) had a pattern of upper-airway collapse during exsufflation. Upper bulbar motor neuron dysfunction was associated with airway obstruction during insufflation (odds ratio 7.19 [95% CI 2.32-22.29], P=.001], whereas lower bulbar motor neuron dysfunction was associated with upper-airway collapse during exsufflation (odds ratio 0.32 [95% CI 0.11-0.98], P=.046). After modifying the settings, a successful MI-E was accomplished in 68 of 70 participants (98.55%). Norris’s bulbar score (odds ratio 0.87 [95% CI 0.78-0.96], P=.007) was the only predictor of no changes to the graphs. A successful strategy for detecting upper-airway reactions and choosing appropriate set parameters was a visual analysis of data produced by implementing MI-E in ALS. Bulbar upper motor neuron dysfunction is associated with obstruction during insufflation, and bulbar lower motor neuron dysfunction is associated with collapse during exsufflation.