Non-invasive positive pressure ventilation and exercise training in patients with stable hypercapnic chronic obstructive pulmonary disease

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a disease with progressive course of dyspnea which leads to reduced health related quality of life (HRQoL). Exercise training has useful effects toward their exercise tolerance and health related quality of life (HRQoL). However extreme breathlessness limits these patients in maintaining exercise training. Non-invasive positive pressure ventilation (NIPPV) is considered a beneficial treatment option for chronic stable hypercapnic respiratory failure. So, the aim of this study is to assess the effect of adding NIPPV to Exercise training program compared to Exercise training program alone in stable hypercapnic COPD patients.Patients and methods: Thirty patients with stable hypercapnic COPD were selected, subdivided into two groups; 15 patients underwent Exercise training alone (Ex. group) and another 15 patients performed Exercises training in association with receiving NIPPV (Ex. + NIPPV group). Baseline and after 3 months assessment of arterial blood gases analysis (ABGs), pulmonary function tests (PFTs), dyspnea scale by modified Medical Research Council (mMRC) and assessment of HRQoL guided by COPD Assessment Test (CAT) were done for both groups.Results: In the Exercise training group, they showed statistical significant improvement in dyspnea scale (mMRC) and CAT score after 3 month performance (p < 0.05), but insignificant changes occurred in their ABGs or PFTs (p > 0.05). While in the Ex. + NIPPV group, a highly statistical significant improvement regarding PCO 2 , FEV 1 and dyspnea scale (mMRC) (p 6 0.001) and a significant difference as regards HRQoL assessment score (p < 0.05) were found after 3 month follow up.Conclusion: Addition of NIPPV to exercise training in patients with stable hypercapnic COPD patients improved PCO 2 , FEV 1 , dyspnea scale and HRQoL.

Effect of pulmonary rehabilitation programme including either O2 inhalation or noninvasive ventilation in patients with chronic obstructive pulmonary disease

“…Contrary to these results, Rooyackers et al [ 51 ] and Wadell et al [ 52 ] claimed no statistically significant change in O 2 saturation and PaCO 2 between the O 2 -trained group and control group, so they reported no additional benefit for super-added oxygen in PR concerning oxygen saturation. Moreover, Cui et al [ 53 ] and Gad et al [ 45 ], in their studies of the role the NIV in PR, showed improvement in spirometric measures, arterial blood gas, dyspnea and QoL in stable hypercapnic COPD patients with significant decrease of PaCO 2 in the NPPV group than (exercise only) group, so it matched with our results. Also, Garrod et al [ 54 ] reported a small improvement in arterial oxygenation in the (NPPV) group in comparison with the (exercise only) group, but with a significant difference between both groups, they explained the increase in PaO 2 in these patients by the improvement in alveolar ventilation and reduced hyperinflation but they stated no significant difference in PaCO 2 after ending their study in both groups.…”

“…Contrary to the present study’s results, Spielmanns et al [ 33 ] noticed no improvement in lung functions in both groups (air-trained and oxygen-trained group) at the end of the PR programme, suggesting that airway obstruction was a permanent cause of exercise limitation. Fakharian et al [ 41 ] and Gad et al [ 45 ] demonstrated improvement in FEV1 and FVC values after the sessions in both groups (PR group and NIV+PR group). However, Duiverman et al [ 46 ] found a more significant improvement in FEV1 in (NIV+PR) than in the PR alone group.…”

Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes in Chronic Obstructive Pulmonary Disease

“…6,7, We included 21 RCTs 6,17,19,20,[23][24][25][26][27][28]30,33,34,[36][37][38][39]41,43,46,48 and 12 observational studies. 18,21,22,29,31,32,35,40,42,44,45,47 These studies were conducted in the United States (n = 4), Canada (n = 1), Europe (n = 23), Asia (n = 3), Africa (n = 1), and Australia (n = 1). All included studies enrolled patients in the home setting, and no studies enrolled patients in assisted living settings.…”

“…An additional 83 citations were identified through reference searching and gray literature search (eFigure in Supplement 2). We included 33 studies (34 articles) evaluating 51 085 patients (mean [SD] age, 65.7 [2.1] years; 43% women) . We included 21 RCTs and 12 observational studies .…”

“…In a separate, prespec ified analysis, 15 RCTs 6,7,17,19,23,24,26,27,33,34,[36][37][38]41,43,46 and 8 observational studies 18,21,22,31,32,35,42,44 1, Figure 2, Figure 3, and Figure 4).…”