Treating COPD

Today, COPD is being treated with a range of therapies that seek to manage long-term function, prevent exacerbations and provide symptomatic relief, including oxygen therapy and non-invasive ventilation (NIV). 

Oxygen therapy

Oxygen therapy is often used as a standard approach to provide relief from hypoxemia and reduce the work of breathing. For COPD patients with hypoxemia, controlled oxygen delivery is indicated for exacerbations, while long-term oxygen therapy has been shown to have survival benefits.1

Individuals prescribed oxygen therapy at home, will likely need a portable oxygen concentrator, a device which separates oxygen from nitrogen in regular air. 

Non-invasive ventilation

Although oxygen alone can help address hypoxia caused by impaired gas exchange in the lung, it does not address hypercapnia caused by carbon dioxide retention alone.

Hypercapnic patients (characterized by increased levels of CO2 in the blood) are primary candidates for non-invasive ventilation (with or without ) as it seeks to improve the patient’s CO2 exchange and support the work of breathing when the patient's own physiology cannot do so effectively. And despite myriad clinical evidence supporting the use of NIV in the hospital for sudden deterioration of chronic hypercapnic respiratory failure due to an exacerbation of COPD, typical treatment after stabilization and discharge often only includes oxygen, medications and inhalers. The role of NIV in the home has yet to be formally adopted, even in light of recent evidence showing improvements in mortality, patient outcomes and a reduced recurrence of acute exacerbations in this patient population.2-5

The following clinical studies below provide evidence for the use of NIV and oxygen therapy in the home. We also encourage you to contact us to discuss which ResMed solution might be right for your patient.

Benefits of NIV with oxygen therapy

The HOT-HMV study shows that home oxygen therapy (HOT) combined with home mechanical ventilation (HMV) can significantly reduce the risk of hospital readmission or death within 12 months by 51% in hypercapnic COPD patients.2

This multi-center, open label, parallel-group, randomized controlled trial investigated the benefits of adding home NIV to oxygen in patients with persistent hypercapnia after an acute COPD exacerbation.

In addition to the 51% reduction in the risk of hospital readmission or death in the HOT-HMV group compared to the HOT-only control group, median admission-free survival time was 4.3 months in the HOT-HMV group compared to 1.4 months for the control group. This translates to an increase of over 90 days in the median time to first event for the HOT-HMV group.2

The risk of hospital readmission or death (within 12 months) was 63.4% in the HOT-HMV group and 80.4% in the HOT group, meaning an absolute risk reduction of 17% (95% CI, 0.1%-34.0%). This translates to a need to treat an average of six patients to avoid one hospital readmission or death in 12 months.2

Definitive impact on survival

A recent publication (September 2014) reported use of home-based NIV in the treatment of hypercapnic respiratory failure secondary to COPD. The trial assessed 195 stable Stage IV COPD patients and investigated the effect of long-term NIV (this study followed the patients for 1 year), targeted to significantly reduce hypercapnia via appropriate ventilator settings. The results showed a substantial improvement in one-year survival (mortality in the NIV group improved by 76% over the non-NIV group) and also quality of life (as measured by four different questionnaires).3

View the full infographic here

Lower readmission rates

A retrospective analysis looked at all patients hospitalized at Temple University Hospital in 2011 with a diagnosis of AECOPD for hypercapnic respiratory failure and who used non-invasive ventilation successfully during hospitalization. Patients who used NIV at home following their hospitalization had lower readmission rates (40% vs 75%) and improved event-free survival after 180 days when compared to those who did not use home NIV.4

Kaplan-Meier curves of event-free survival comparing patients who used home NIV versus patients who did not use home NIV.4

 

Reduced risk of recurrent respiratory failure

A pilot study was designed to compare continuation of active home NIV and continuous positive airway pressure (CPAP) in COPD patients who had been successfully treated with acute NIV for acute hypercapnic respiratory failure (AHRF). The results showed that home NIV reduces the recurrence of acute hypercapnic respiratory failure following an initial event by 60.2% in the first 30 days following the event when compared to CPAP (38.5%).4 The results of this study provides support for the use of home NIV for COPD patients that have survived an episode of respiratory failure.

Kaplan-Meier curves showing reduced rate of recurrent AHRF in COPD patients given home NIV, compared with patients given CPAP.5

\

References

  • 01

    McKenzie DK et al. The COPDX Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2003. Med J Aust. 2003;178 (6):S15-29.

  • 02

    P. Murphy et al., Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation. A Randomized Clinical Trial, JAMA. Published online May 21, 2017. doi:10.1001/jama.2017.4451.

  • 03

    Köehnlein T et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease - A prospective, multicentre, randomized, controlled clinical trial. Lancet Respir Med 2014;2:698-705.

  • 04

    Galli JA, et al., Home non-invasive ventilation use following acute hypercapnic respiratory failure in COPD, Respiratory Medicine 2014 http://dx.doi.org/10.1016/j.rmed.2014.03.006.

  • 05

    Cheung et al. A pilot trial of non-invasive home ventilation after acidotic respiratory failure in chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2010;14:642-649