The ERS sessions included some interesting updates on key topics in NIV, including cost effectiveness, therapy adherence and the use of mouthpieces for COPD.
Detection by eNose of clinical instability prior to a reported exacerbation in COPD patients.
The SpiroNose was shown to identify patients who were clinically unstable 3 months prior to a reported exacerbation. Job J.M.H et al.
Exhaled volatile organic compounds (VOCs) could predict readmission to hospital.
In patients who were readmitted within 30 days post exacerbation, VOCs could predict this re-admission with 87.5% accuracy, 90% sensitivity and 76.5% specificity (P<0.001). Rodrigo Trayano A/M. et al. Read the study
The best predictors of mortality are neural respiratory drive, PaCO2 at admission, previous long term oxygen use and age >71 years. Patout M. et al. Read the study
A post-hoc analysis of the FLAME study showed that patients with low baseline dyspnoea had a lower annualised exacerbation rate and experienced less severe symptoms compared with those with high baseline dyspnoea. Mackay A et al. Read the study
The most up-to-date research in the field of dyspnoea and a patient’s perspective of living with COPD.
Andreas von Leupoldt discussed the psychological factors associated with dyspnoea. Like pain, dyspnoea consist of two aspects: a sensory dimension (intensity) and an affective one (unpleasantness). His research has shown that during high negative emotionality, individual perception of the unpleasantness aspect of dyspnoea can be more pronounced than the intensity.
Studies have shown that dyspnoeic patients with comorbid depression or anxiety show inadequate use of medications, more frequent visits to physician and higher rehospitalisation than those who do not have depression. This vicious cycle needs to be broken by identifying these patients early and providing them with appropriate care.
A patient gave a very enlightening perspective on the challenges of living with COPD. He explained that everything takes more time and that the mornings are the most difficult time of day. His breathlessness can be triggered by a variety of things including smells such as perfume. His recommendations for other patients with COPD are to ‘exercise, find support, know your limitations, use a POC and get out and mingle’.
There is an increasing focus on patient-centred approaches to improving treatment strategies and chronic disease management. Clustering and phenotyping patients based on their symptoms is useful to understand their needs. Depression and anxiety are common in patients with COPD and targeting education and support in those with anxieties may improve outcomes. From a patient perspective, it is important to find support among other COPD patients.
Dr Carlin emphasised the benefits of adopting telemonitoring for home NIV, notably in terms of reducing length of stay and hospital re-admissions, and discussed instructive clinical cases.
Pr Gonzalez-Bermejo gave an overview of positive and negative studies on the use of home NIV in COPD, highlighting the role of high-intensity NIV.
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Improving Prediction of Risk of Hospital Admission in Chronic Obstructive Pulmonary Disease : Application of Machine Learning to telemonitoring Data
There is a lack of tools to address patient-centred outcomes in NIV treatment. The S3-NIV questionnaire gives clinicians and patients a reliable tool to optimise NIV management.
An interesting paper that uses measurable physiologic variables and worsening symptoms to predict COPD exacerbations.
Boers et al.
Update: non-invasive ventilation in chronic obstructive pulmonary disease
Several recent RCTs have demonstrated favourable outcomes with domiciliary NIV (…) This has the potential to significantly change clinical practice and has implications for long-term management of end-stage COPD patients and the costs associated with their management.
Neeraj Mukesh Shah et al.
Successful NIV therapy depends on a wide range of clinical expertise and/or a skilled multidisciplinary team.