Long-Term Home Noninvasive Mechanical Ventilation Increases Systemic Inflammatory Response in Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

Abstract

Background. Long-term home noninvasive mechanical ventilation (NIV) is beneficial in COPD but its impact on inflammation is unknown. We assessed the hypothesis that NIV modulates systemic and pulmonary inflammatory biomarkers in stable COPD. Methods. Among 610 patients referred for NIV, we shortlisted those undergoing NIV versus oxygen therapy alone, excluding subjects with comorbidities or non-COPD conditions. Sputum and blood samples were collected after 3 months of clinical stability and analyzed for levels of human neutrophil peptides (HNP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-alpha). Patients underwent a two-year follow-up. Unadjusted, propensity-matched, and pH-stratified analyses were performed. Results. Ninety-three patients were included (48 NIV, 45 oxygen), with analogous baseline features. Sputum analysis showed similar HNP, IL-6, IL-10, and TNF-alpha levels (P > 0.5). Conversely, NIV group exhibited higher HNP and IL-6 systemic levels (P < 0.001) and lower IL-10 concentrations (P < 0.001). Subjects undergoing NIV had a significant reduction of rehospitalizations during follow-up compared to oxygen group (P = 0.005). These findings were confirmed after propensity matching and pH stratification. Conclusions. These findings challenge prior paradigms based on the assumption that pulmonary inflammation is per se detrimental. NIV beneficial impact on lung mechanics may overcome the potential unfavorable effects of an increased inflammatory state.

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

“…This classification has informed the presentation of results (see Clinical effectiveness results: non-invasive ventilation versus usual care and Clinical effectiveness results: non-invasive ventilation versus non-invasive ventilation) and the economic evaluation scenarios (see Clinical effectiveness review discussion). Note that there is limited information on time since last exacerbation (for either population), with the exception of the controlled study by Paone et al (2014) 89 where all patients were enrolled 3 months after discharge from hospital after an exacerbation; they were free from exacerbations for at least 4 weeks and, therefore classified as stable. 87,88 Data were sought on patients' exacerbation history in order to make an assessment of whether any could be described as frequent exacerbators.…”

“…Most studies provided no information. One RCT 92 stated that all patients had had previous exacerbations and three non-randomised controlled studies in stable populations 89,93,94 specified at least one previous admission because of severe exacerbation.…”

“…76,78,81,84,92 Only four out of nine 89,[93][94][95] non-randomised controlled studies provided clear details.…”

“…Of the 10 controlled studies, five 89,[93][94][95][96] had a prospective design and five appeared to be retrospective analyses of data, although this was not always clearly described. One prospective study 89 used a matched design, which may result in more similar groups at baseline and thus less biased results. Retrospective studies are more prone to bias, as outcome measurements and usual care cannot be retrospectively standardised for both groups.…”

“…because of mask intolerance) or did not want to continue; however, in three retrospective studies, 86,88,97 levels of blood gases determined eligibility for NIV, and one retrospective study 98 gave no details. All prospective studies 89,[93][94][95][96] and one of the retrospective studies 98 gave details on similarity between NIV and usual-care groups in terms of baseline characteristics, and there appeared to be no major differences. There were no details in one retrospective study, 87 and the other three may have differences in blood gas levels as these determined eligibility for NIV.…”