Would the concerns about respiratory side effects from sodium phenylbutyrate and taurusodiol change your management of patients with predominantly bulbar ALS?

When you say "respiratory side effects" I assume you are referring to the rate of upper respiratory tract infections being higher in the Relyvrio-treated patients compared to the placebo-treated ones. I cannot think of a reason this product would make patients more susceptible to respiratory infecti...

I am not sure what respiratory side effects are intended, as no specific ones were included in the Paganoni et al., PMID 32877582 article. In clinic, I assess for respiratory symptoms and perform pulmonary function tests and treat all patients the same for respiratory involvement independent of site...

Side effects seen in the trial should be discussed. However, most people would agree that there is a favorable benefit/risk ratio in the context of ALS.