Abstract
Effectiveness of long-term non-invasive ventilation (NIV) in COPD is controversial.
In a retrospective and monocentric study we compared the rate of hospitalizations for exacerbation, and survival in 165 patients subdivided in 2 groups. Group 1 included 90 patients treated with home NIV between 1990 and 2012 after an exacerbation and group 2 included 75 patients treated with home NIV after a progressive worsening of the disease.
At baseline, except a higher prevalence of OSA in group 2 compared with group 1 (37% vs 20%, p <0.02), clinical features, comorbidities and lung function tests of the 2 groups of patients were similar (age: 67 ± 10 years, men: 78%, body mass index: 31 ± 8 kg / m2, FEV1: 34% ± 15 predicted value). The median survival was 36 months, the survival of the group 2 was significantly better in the first period (before 2001) and hospitalizations for exacerbation were reduced by 42% (p = 0.002) after 12 months of NIV compared with the 12 months before NIV (-62% and -17% in group 1 and 2, respectively). After 3 months of NIV, there was a non significant improvement in PaCO2 without change in forced vital capacity nor FEV1. In multivariate analysis, independent factors associated with survival were age, cardiovascular comorbidities and dyslipidemia.
In conclusion, the rate of hospitalizations for COPD exacerbation could be significantly reduced under long-term NIV. A better screening and care for cardiovascular comorbidities could further reduce mortality.
- Copyright ©ERS 2015