Noninvasive ventilation in stable hypercapnic COPD: what is the evidence?

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Abstract

Long-term noninvasive ventilation (NIV) to treat chronic hypercapnic respiratory failure is still controversial in severe chronic obstructive pulmonary disease (COPD) patients. However, with the introduction of high-intensity NIV, important benefits from this therapy have also been shown in COPD. In this review, the focus will be on the arguments for long-term NIV at home in patients with COPD. The rise of (high-intensity) NIV in COPD and the randomised controlled trials showing positive effects with this mode of ventilation will be discussed. Finally, the challenges that might be encountered (both in clinical practice and in research) in further optimising this therapy, monitoring and following patients, and selecting the patients who might benefit most will be reviewed.

Abstract

Adequately set chronic NIV improves outcomes in COPD patients with severe chronic hypercapnic respiratory failure http://ow.ly/slW230i8lck

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Most cited references 75

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Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation : A Randomized Clinical Trial

Patrick B. Murphy, Sunita Rehal, Gill Arbane … (2017)

Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death.

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Predictors of rehospitalization and death after a severe exacerbation of COPD.

Ryan McGhan, Tiffany Radcliff, Ron Fish … (2007)

Patients who survive a severe exacerbation of COPD are at high risk of rehospitalization for COPD and death. The objective of this study was to determine predictors of these events in a large cohort of Veterans Affairs (VA) patients. We identified 51,353 patients who were discharged after an exacerbation of COPD in the VA health-care system from 1999 to 2003, and determined the rates of rehospitalization for COPD and death from all causes. Potential risk factors were assessed with univariate and multivariate survival analysis. On average, the cohort was elderly (mean age, 69 years), predominately white (78% white, 13% black, 3% other, and 6% unknown), and male (97%), consistent with the underlying VA population. The risk of death was 21% at 1 year, and 55% at 5 years. Independent risk factors for death were age, male gender, prior hospitalizations, and comorbidities including weight loss and pulmonary hypertension; nonwhite race and other comorbidities (asthma, hypertension, and obesity) were associated with decreased mortality. The risk of rehospitalization for COPD was 25% at 1 year, and 44% at 5 years, and was increased by age, male gender, prior hospitalizations, and comorbidities including asthma and pulmonary hypertension. Hispanic ethnicity and other comorbidities (diabetes and hypertension) were associated with a decreased risk of rehospitalization. Age, male gender, prior hospitalizations, and certain comorbid conditions were risk factors for death and rehospitalization in patients discharged after a severe COPD exacerbation. Nonwhite race and other comorbidities were associated with decreased risk.

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Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial.

Joseph D. Hillman, P Catcheside, A Esterman … (2009)

Sleep hypoventilation has been proposed as a cause of progressive hypercapnic respiratory failure and death in patients with severe chronic obstructive pulmonary disease (COPD). A study was undertaken to determine the effects of nocturnal non-invasive bi-level pressure support ventilation (NIV) on survival, lung function and quality of life in patients with severe hypercapnic COPD. A multicentre, open-label, randomised controlled trial of NIV plus long-term oxygen therapy (LTOT) versus LTOT alone was performed in four Australian University Hospital sleep/respiratory medicine departments in patients with severe stable smoking-related COPD (forced expiratory volume in 1 s (FEV1.0) 46 mm Hg and on LTOT for at least 3 months) and age 20/h) or morbid obesity (body mass index >40) were excluded. Outcome measures were survival, spirometry, arterial blood gases, polysomnography, general and disease-specific quality of life and mood. 144 patients were randomised (72 to NIV + LTOT and 72 to LTOT alone). NIV improved sleep quality and sleep-related hypercapnia acutely, and patients complied well with therapy (mean (SD) nightly use 4.5 (3.2) h). Compared with LTOT alone, NIV (mean follow-up 2.21 years, range 0.01-5.59) showed an improvement in survival with the adjusted but not the unadjusted Cox model (adjusted hazard ratio (HR) 0.63, 95% CI 0.40 to 0.99, p = 0.045; unadjusted HR 0.82, 95% CI 0.53 to 1.25, p = NS). FEV1.0 and PaCO2 measured at 6 and 12 months were not different between groups. Patients assigned to NIV + LTOT had reduced general and mental health and vigour. Nocturnal NIV in stable oxygen-dependent patients with hypercapnic COPD may improve survival, but this appears to be at the cost of worsening quality of life. ACTRN12605000205639.

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Journal

Journal ID (nlm-ta): ERJ Open Res

Journal ID (iso-abbrev): ERJ Open Res

Journal ID (publisher-id): ERJOR

Journal ID (hwp): erjor

Title: ERJ Open Research

Publisher: European Respiratory Society

ISSN (Electronic): 2312-0541

Publication date Collection: April 2018

Publication date (Electronic): 09 April 2018

Volume: 4

Issue: 2

Electronic Location Identifier: 00012-2018

Affiliations

[1 ]Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

[2 ]Groningen Research Institute of Asthma and COPD, University of Groningen, Groningen, The Netherlands

Author notes

M.L. Duiverman, University Medical Center Groningen, Postbox 30.001, 9700 RB Groningen, The Netherlands. E-mail: m.l.duiverman@ 123456umcg.nl

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Publisher ID: 00012-2018

DOI: 10.1183/23120541.00012-2018

PMC ID: 5890025

PubMed ID: 29637078

SO-VID: 9b9acd83-1db5-444b-80ec-af98ccac64e3

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This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

Noninvasive ventilation in stable hypercapnic COPD: what is the evidence?

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Most cited references 75

Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation : A Randomized Clinical Trial

Predictors of rehospitalization and death after a severe exacerbation of COPD.

Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial.

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