We thank M.L. Duiverman, F.M. Struik and P.J. Wijkstra for the relevant comments and agree that development of new therapeutic options in severe-stable chronic obstructive pulmonary disease is required.
We concur that the results are based mainly on nonrandomised controlled trials that exhibited considerable heterogeneity. Furthermore, factors such as achieving effective ventilation, determining inspiratory pressures and selecting patients who benefit most are only some of the areas identified that need further study. Clearly there are knowledge gaps. Most studies reviewed limited the ability to draw conclusions, with further research needed in order to confirm positive findings related to noninvasive ventilation in severe-stable chronic obstructive pulmonary disease patients. This and other techniques require testing in carefully designed and conducted trials, for which there were few.
Our rationale for conducting this review was to assess what is known and not known. Based on the existing evidence, noninvasive ventilation may have an adjunctive role in the management of chronic respiratory failure due to chronic obstructive pulmonary disease.
Statement of interest
None declared.
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