PT  - JOURNAL ARTICLE
AU  - Perez-Bautista, Oliver
AU  - Ramírez Venegas, Alejandra
AU  - Velazquez Uncal, Monica
AU  - Hernandez-Zenteno, Rafael
AU  - Flores-Trujillo, Fernando
AU  - Velazquez-Montero, Alejandra
AU  - Sansores, Raul H.
TI  - Non invasive positive pressure ventilation for reducing exacerbation in very severe chronic obstructive pulmonary disease (COPD)
AID  - 10.1183/13993003.congress-2016.PA3051
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA3051
VI  - 48
IP  - suppl 60
4099  - https://publications.ersnet.org//content/48/suppl_60/PA3051.short
4100  - https://publications.ersnet.org//content/48/suppl_60/PA3051.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - 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.