Increased ventilation with NiIPPV does not necessarily improve exercise capacity in COPD

Highcock, Martin; Shneerson, J M; Smith, Ian

doi:10.1183/09031936.03.00292203

Cited by 20 publications

(21 citation statements)

References 30 publications

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“…All prior studies evaluating NIV assessed exercise tolerance via the 6-min walk test or shuttle walk test and showed no improvement in the NIV groups, 18,19,[24][25][26] in agreement with our findings.…”

Section: Discussionsupporting

confidence: 82%

Noninvasive Ventilation in Mustard Airway Diseases

2015

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BACKGROUND: Noninvasive ventilation (NIV) has been shown to improve numerous clinical measures in subjects with COPD, including gas exchange, exercise tolerance, dyspnea, hospitalizations, health-related quality of life (HRQOL), and functional status. Although useful for classical COPD, NIV has not been validated specifically as a treatment option for mustard airway disease. Our aim was to assess the efficacy of NIV in subjects with severe mustard airway disease. METHODS: This study was performed over the course of 12 months on 20 subjects with severe mustard airway disease (Global Initiative for Chronic Obstructive Lung Disease criteria). Subjects were selected from the pulmonary clinic of Baqiyatallah Hospital in Tehran, Iran. Body mass index, lung function, dyspnea, exercise tolerance, HRQOL, sleep quality, and hospitalization measures were assessed before and after NIV treatment. RESULTS: NIV improved HRQOL (P ‫؍‬ .03) and sleep quality (P ‫؍‬ .06) in very severe subjects and reduced hospitalizations (P ‫؍‬ .003) and exacerbations (P ‫؍‬ .01) in severe subjects. Chest imaging studies showed that these subjects had heterogeneous airway disease, the main finding of which was bronchiolitis obliterans. CONCLUSIONS: NIV can be used as an effective new palliative method in the treatment of mustard airway disorders.

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Section: Discussionsupporting

confidence: 82%

Noninvasive Ventilation in Mustard Airway Diseases

2015

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“…6). Combined data for four studies [17,18,25,26] showed an increase in VT/tI (p50.02); however, heterogeneity was evident (p50.45; [26,27] showed an increase in respiratory muscle strength with bilevel NIPPV, although heterogeneity was evident (table 9 and fig. 9).…”

Section: Lung Functionmentioning

confidence: 98%

“…Meta-analysis of five non-RCTs [17,18,[26][27] that assessed ventilatory/breathing pattern parameters with bilevel NIPPV showed an increase in VT (MD 195.64 mL, 95% CI 21.97-369.31 mL; p50.03; table 6 and fig. 6).…”

Section: Lung Functionmentioning

confidence: 99%

“…Improvements in some flow and volume indices (V9E, VT, VT/tI) in studies that assessed ventilation/breathing pattern were reported with bilevel NIPPV use [17,18,24,27]. Two daytime studies [17,19] found that the extent of the increase in VT was greater with higher bilevel pressures (IPAP/EPAP pressure difference of 1.5 kPa (o15 cmH 2 O)), suggesting that the degree of improvement in alveolar ventilation with bilevel NIPPV may be proportional to the IPAP/EPAP pressure difference applied.…”

Section: Respiratory Functionmentioning

confidence: 99%

“…Due to the combined interventions (bilevel NIPPV and exercise), it is not clear whether noninvasive ventilation alone or in combination with exercise contributed to the improvement. Two non-RCTs [18,29] that assessed exercise tolerance (one using the 6MWT [29] and the other using the SWT [18]) showed no improvement with bilevel NIPPV. CASANOVA et al [11] showed a reduction in dyspnoea at 3 months on two dyspnoea scales (p50.035, MRCD; p50.039, Borg scale) and this improvement was maintained at 6 months on the Borg scale (p50.033) in the bilevel NIPPV with LTOT group.…”

Section: Health-related Outcomesmentioning

confidence: 99%

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Systematic review of noninvasive positive pressure ventilation in severe stable COPD

Kolodziej¹,

Jensen²,

Rowe³

et al. 2007

European Respiratory Journal

136

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The present systematic review examined the effectiveness of bilevel noninvasive positive pressure ventilation (NIPPV) in the management of chronic respiratory failure (CRF) due to severe stable chronic obstructive pulmonary disease (COPD).Randomised controlled trials (RCTs) and non-RCTs (crossover design) of adults with severe stable COPD and CRF receiving bilevel NIPPV via nasal, oronasal or total face mask were identified from electronic databases and manual screening of journals and reference lists.Respiratory function (gas exchange, lung function, ventilatory/breathing pattern, respiratory muscle function and work of breathing) and health-related outcomes (dyspnoea, functional status, exercise tolerance, health-related quality of life (HRQOL), morbidity and mortality) were assessed.In total, 15 studies met the inclusion criteria: six RCTs and nine non-RCTs. RCTs did not find improved gas exchange with bilevel NIPPV, while non-RCTs did. Lung hyperinflation and diaphragmatic work of breathing were reduced in a nonrandomised subset. HRQOL and dyspnoea, the least studied outcomes, showed improvement with bilevel NIPPV.In a subset of individuals on maximal medical treatment regimes for severe stable chronic obstructive pulmonary disease, bilevel noninvasive positive pressure ventilation may have an adjunctive role in the management of chronic respiratory failure through attenuation of compromised respiratory function and improvement in health-related outcomes.KEYWORDS: Chronic obstructive pulmonary disease, chronic respiratory failure, noninvasive positive pressure ventilation, systematic review C hronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD) contributes a significant social and economic burden to individuals, families and the healthcare system. The incidence of COPD, in terms of its combined mortality and disability, was the 12th highest for diseases worldwide in 1990 and is expected to become the fifth highest by 2020, with mortality expected to increase fivefold by 2015 [1][2][3]. The rate of progression, the extent of airflow obstruction and airway hyperreactivity, and the impairment in alveolar ventilation and gas exchange contribute to the heterogeneity of COPD and the extent of chronic bronchitic versus emphysematous change that occurs. Reduced alveolar ventilation in CRF due to COPD results in nocturnal and daytime gas exchange abnormalities, sleep-disordered breathing, dyspnoea and increased work of breathing, which in turn lead to significant functional impairment, morbidity and mortality [4]. The eventual development of CRF is characterised by varying degrees of ventilation-perfusion mismatch, hypoxia and hypercapnia [5]. Reduced respiratory reserve associated with ongoing morbidity renders COPD patients at risk of acute respiratory decompensation [6,7]. Symptom management and prevention of respiratory decompensation are important in reducing morbidity and mortality associated with COPD.The use of bilevel noninvasive positive pressure ventilation (NIPPV)...

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