The second part is a comparison of respiratory outcomes in patients receiving telemedicine-guided respiratory assessments monthly vs. those receiving standard of care. This is a randomized controlled study which assesses the effects rPFT on respiratory outcomes, quality of life, and survival. Forty patients with ALS will be randomized into two arms, both receiving standard respiratory assessments for pulmonary function every three months, and the experimental group additionally receiving rPFTs in the interim months over the course of a year. The primary hypothesis is that home respiratory assessment enables thresholds for NIV recommendation to be met in the experimental group significantly closer to the initiation criteria, at a time when quality of life is higher, compared to the control group.