Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death worldwide, and a major economic burden on healthcare systems. Treatment of COPD with Non-Invasive Ventilation (NIV) has been shown to be effective in treating acute exacerbations of COPD, assisting pulmonary rehabilitation in COPD patients, and providing benefits in managing chronic hypercapnic COPD patients.
NIV in management of acute exacerbation of COPD
There is strong evidence recommending NIV in the management of acute respiratory failure associated with COPD exacerbations. The 2011 GOLD guidelines1 state that NIV improves respiratory acidosis, and decreases respiratory rate, severity of breathlessness including complications such as ventilator associated pneumonia, and length of hospital stay are reduced, more importantly reduces mortality and intubation rate.
In a Chochrane systematic review of studies which have compared NIV with standard care, NIV was associated with lower mortality, reduced need for intubation, and greater improvements in pH, PaCO2, and respiratory rate after 1 hour. NIV also resulted in fewer complications and reduced hospital stay2.
Continued use of NIV after hospitalisation due to COPD exacerbations has also been shown to reduce the risk of recurrent exacerbations and clinical worsening3,4. A recent review found that using NIV post COPD acute exacerbation led improved event-free survival rates and reduced hospital admissions5.
NIV in Pulmonary Rehabilitation
The GOLD Guidelines stated that all COPD patients could benefit from pulmonary rehabilitation and maintenance of physical activity1. NIV during pulmonary rehabilitation can:
- Improve oxygenation and gas exchange6,8
- Increase exercise intensity and duration6,7
- Decrease dyspnoea6
- Improve several measures of health-related quality of life8
NIV in the management of stable COPD
The GOLD guidelines recommend that a combination of NIV and long term oxygen therapy may be beneficial in selected COPD patients, particularly those with hypercapnic COPD1. There is evidence that NIV in conjunction with other therapies in stable hypercapnic patients may improve:
- Blood gases and lung function9,10,11,14
- Hospital ICU admissions9
- Quality of life9,10,11
The effect of NIV on mortality in COPD patients is still unclear. However smaller clinical trials have shown that NIV may improve survival rates12. In particular, high inspiratory pressures (also known as high intensity NIV) is associated with favourable long term outcomes in patients13,14.
Ram F, Picot J, Lightowler J, Wedzicha J. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2004; CD004104.
Funk GC, Breyer MK, Burghuber OC, Kink E, Kirchheiner K, Kohansal R, Schmidt I, Hartl S. Long-term non-invasive ventilation in COPD after acute-on-chronic respiratory failure Respir Med 2011; 105(3):427-34.
Cheung AP, Chan VL, Liong JT, Lam JY, Leung WS, Lin A, Chu CM. A pilot trial of non-invasive home ventilation after acidotic respiratory failure in chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2010; 14(5):642-9.
Corner E, Garrod R. Does the addition of non-invasive ventilation during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease augment patient outcome in exercise tolerance? A literature review. Physiother Res Int 2010; 15(1):5-15.
Duiverman ML, Wempe JB, Bladder G, Jansen DF, Kerstjens HA, Zijlstra JG, Wijkstra PJ. Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD. Thorax 2008; 63(12):1052-7.
Clini E, Sturani C, Rossi A, Viaggi S, Corrado A, Donner CF, Ambrosino N. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. Eur Respir J 2002; 20(3):529-38.
Tsolaki V, Pastaka C, Karetsi E, Zygoulis P, Koutsokera A, Gourgoulianis KI, Kostikas K. One-year non-invasive ventilation in chronic hypercapnic COPD: effect on quality of life. Respir Med 2008; 102(6):904-11.
McEvoy RD, Pierce RJ, Hillman D, Esterman A, Ellis EE, Catcheside PG, O'Donoghue FJ, Barnes DJ, Grunstein RR. Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial. Thorax 2009; 64(7):561-6.
Budweiser S, Hitzl AP, Jorres RA, Heinemann F, Arzt M, Schroll S, Pfeifer M. Impact of noninvasive home ventilation on long-term survival in chronic hypercapnic COPD: a prospective observational study. Int J Clin Pract 2007; 61(9):1516-22.