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Physiological and clinical effects of diurnal noninvasive ventilation in hypercapnic COPD

¹ Dept of Respiratory Diseases and, ³ Dept of Medicine, Universidad Católica de Chile, Santiago, Chile. ² Respiratory Division, Complexe hospitalier de la Sagamie, Chicoutimi, Dept of Medicine, University of Montreal, Canada.

CORRESPONDENCE: O. Díaz, Dept of Respiratory Diseases, Universidad Católica de Chile, Marcoleta 345, Piso 4. Santiago, Chile. Fax: 562 6335255. E-mail: diazp{at}rdc.cl

Keywords: Chronic obstructive pulmonary disease, dyspnoea, exercise capacity, hypercapnia, noninvasive ventilation

Received: March 22, 2005
Accepted August 11, 2005

To assess the clinical impact of noninvasive mechanical ventilation (NIMV) on stable hypercapnic chronic obstructive pulmonary disease, changes in exercise capacity, dyspnoea and simple physiological parameters were evaluated. The time course of these effects during treatment and recovery was also assessed.

Patients were randomly allocated to NIMV (n = 27) or sham-NIMV (n = 15), applied 3 h·day^–1, 5 days a week, for 3 weeks. A 6-min walking distance (6MWD), arterial blood gases, spirometry, pattern of breathing, mouth occlusion pressure (P_0.1), and respiratory system impedance (P_0.1/tidal volume (V_T)/inspiratory time (t_I)) were measured weekly during treatment and 2 weekly during follow-up. Transition dyspnoea index (TDI) was also measured.

During NIMV, carbon dioxide arterial tension decreased progressively, concomitantly with a slow deep pattern of breathing, a proportional increase in the forced expiratory volume in one second (FEV₁₎, the forced vital capacity and significant reductions of P_0.1 and P_0.1/V_T/t_I. The 6MWD improved by a mean of 76 m after NIMV, and by 73 m and 61 m 1 and 2 weeks, respectively, after treatment. Dyspnoea improved with a mean TDI of three points. Changes in 6MWD were highly related to TDI and to a lesser extent to changes in FEV₁ (r = 0.60).

The current authors conclude that noninvasive mechanical ventilation has significant and sustained clinical impact in stable hypercapnic chronic obstructive pulmonary disease.

This article has been cited by other articles:

				M. L. Duiverman, F. M. Struik, and P. J. Wijkstra Noninvasive ventilation in severe stable COPD: is it effective, and if so, in what way? Eur. Respir. J., May 1, 2008; 31(5): 1136 - 1137. [Full Text] [PDF]

				A C Young, J W Wilson, T C Kotsimbos, and M T Naughton Randomised placebo controlled trial of non-invasive ventilation for hypercapnia in cystic fibrosis Thorax, January 1, 2008; 63(1): 72 - 77. [Abstract] [Full Text] [PDF]

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