Non-invasive ventilation during walking in patients with severe COPD: A randomized cross-over trial

¹ Dept of Pneumology, University Hospital Freiburg, Germany

^* To whom correspondence should be addressed. E-mail: wolfram.windisch{at}uniklinik-freiburg.de.

	Abstract

It was hypothesized that non-invasive positive pressure ventilation (NPPV) applied during walking avoids exercise induced hypoxemia and improves exercise performance in severe COPD patients already receiving long-term NPPV.

Twenty COPD patients (65.1±8.7 years [mean±SD], FEV₁ 27±8 %predicted, TLC 116±27 %predicted) reporting dyspnoea even during mild exertion underwent two six minute walking tests with a rollator and supplemental oxygen (2.1±0.9 L·min^-1) in a randomized cross-over design: with and without pressure-limited NPPV as used at home (inspiratory/expiratory pressure 29±4/4±1 mbar, respiratory rate 20±2·min^-1).

PaO₂ after walking increased by 10.5±10.8 mmHg (95%CI 5.4/15.6 mmHg; P<0.001) with NPPV, but decreased by 10.8±8.0 mmHg (95%CI -14.5/-7.1 mmHg; P<0.001) without NPPV. dyspnoea as assessed by the Borg dyspnoea Scale decreased from 6 (interquartile range 4.5/10) to 4 (interquartile range 1.5/4.5) (P<0.001) and walking distance increased from 209 (interquartile range 178/279) to 252 (interquartile range 203/314) m (P=0.027) when walking was NPPV-aided.

In chronic hypercapnic COPD high intensity NPPV can also be administered during walking with unchanged ventilator settings compared to settings used at rest, thus resulting in improved oxygenation, decreased dyspnoea and increased walking distance. Therefore, NPPV during walking could prevent hypoxia induced complications and could play a future role in palliative care.

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