Objectives : To evaluate the correlation between bulbar symptoms, swallowing, and respiratory function in patients with amyotrophic lateral sclerosis (ALS), and to determine the clinical utility of the Korean version of the ALS Functional Rating Scale-Revised (K-ALSFRS-R) in predicting objective swallowing and pulmonary function test results. Method : This retrospective cross-sectional study reviewed the medical records of 80 patients with ALS. Functional status was assessed using the K-ALSFRS-R, a patient-reported outcome measure (PROM). In particular, bulbar symptoms were evaluated using the bulbar domain subscore (b-K-ALSFRS-R), which comprises items related to speech, swallowing, and salivation. Swallowing function was assessed using videofluoroscopic swallowing studies (VFSS), specifically measuring oral transit time (OTT) and Penetration-Aspiration Scale (PAS) scores for liquid, semisolid and solid consistencies. Respiratory function was evaluated through pulmonary function tests (PFT), including forced vital capacity (FVC), peak cough flow (PCF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), measured in both supine and sitting positions. Pearson's correlation coefficients were used for statistical analysis. Results : The mean age of the 80 patients with ALS was 60 years, with a male-to-female ratio of 1.8:1. The average disease duration was 2.7 years. The mean total scores for the K-ALSFRS-R and b-K-ALSFRS-R were 18.8 and 6.4, respectively. The b-K-ALSFRS-R score showed significant correlations with both PFT and VFSS parameters (OTT and PAS scores for liquid and solid diet). In contrast, while the total K-ALSFRS-R score was significantly correlated with PFT parameters, it was not significantly associated with VFSS results. Conclusions : Bulbar symptoms, as measured by the b-K-ALSFRS-R, may serve as a useful clinical indicator of both dysphagia and respiratory decline in patients with ALS.