Long-term effects of Noninvasive ventilation (NIV) on exacerbations rate and mortality in stable hypercapnic COPD patients

Abstract

Background: Although home NIV use in stable hypercapinc COPD patients is suggested, the benefits of this intervention are still controversial.

Aims and Objectives: To investigate the effect of long-term NIV use on the rate and severity of acute exacerbations, clinical symptoms and mortality in patients with hypercapnic COPD.

Methods: NIV in the spontaneous/timed mode was administered in stable hypercapnic COPD patients 3-4 weeks after admission for acute-on-chronic hypercapnic respiratory failure. Exclusion criteria were: a) BMI>35 kg/m2, b) diagnosed or clinical suspicion of OSA, c) unable to tolerate NIV or poor compliance. Number of exacerbations, arterial blood gases and COPD Assessment Test (CAT) were assessed before and 2 years after NIV initiation. Severe exacerbation was defined as hospitalization and moderate was defined as treatment with systemic corticosteroids and/or antibiotics.

Results: 64 patients (75% men, mean age 70) were included. From baseline to 24 months, there was a significant improvement in moderate (1 vs 1.9, p=0.007) and severe exacerbations (0.5 vs 1.6, p=0.001), CAT score (p<0.001), PO2 (p<0.001) and PCO2 (p<0.001). Patients who responded positively to NIV were >70 years, had higher PO2 at baseline (60 vs 52 mmHg) and lower prevalence of comorbidities compared to non responders. 29% of patients died, 6-32 months after NIV initiation. Patients with lower FEV1 and increased PCO2 at baseline were found to have a greater risk of death (p<0.001).

Conclusions: Early NIV in stable COPD patients, when needed, seems to have beneficial effect on rate and severity of exacerbations, arterial blood gases and clinical symptoms.