Non invasive positive pressure ventilation for reducing exacerbation in very severe chronic obstructive pulmonary disease (COPD)

Abstract

For very severe COPD patients with frequent exacerbations, non-invasive positive pressure ventilation (NIPPV) may an alternative to reduce exacerbations.

Objective: To evaluate the impact of the high-intensity non-invasive positive pressure ventilation (HI-NIPPV) in patients with stable normocapnic very severe COPD (Forced Expiratory Volume in the first second (FEV₁) lower than 30%p) on the frequency of exacerbations.

Methods: A randomized, double blind, clinical trial study. Fifty eligible patients were randomized to receive HI-NIPPV (nspiratory positive pressure of 22 cm H2O or higher) or the sham intervention (S-NIV) during one year. The inclusion criteria were the presence of FEV₁ < 30%p and 2 or more exacerbations in the past year.

Results: No differences were found at baseline between groups in number of exacerbation, FEV₁, dyspnea, exercise capacity, gas exchange, and quality of life. The compliance to the NIPPV was in average 10 hours/day and 26 ± 4cmH2O was the IPAP used in the HI-NIPPV group. The overall reduction in the rate of exacerbations mostly explained by mild and moderate exacerbations was observed in the HI-NIPPV treatment group (reduction by 55%) compared with the S-NIV [0.38 (0.24-0.51) versus 0.22 (0.15-0.29), p =0.012]. The 20% reduction in the rate of severe exacerbations with HI-NIPPV group treatment compared with the S-NIV was not significantly different. Only Dyspnea and PaCO2, showed significant improvement with the HI-NIPPV in comparison with the S-NIV.

Conclusions: HI-NIPPV may be a useful additional intervention to prevent mild and moderate exacerbations in patients with severe airflow limitation.