Noninvasive positive pressure ventilation in stable patients with COPD

Abstract

Purpose of review Long-term noninvasive positive pressure ventilation (NIV) used to be a controversial form of therapy for patients with stable hypercapnic chronic obstructive pulmonary disease (SH-COPD). New evidence described in this review defines the optimal settings, timing and target population for NIV utilization in SH-COPD necessary to maximize its benefit. Recent findings NIV, when titrated appropriately, leads to improved clinical outcomes. High inspiratory positive airway pressures aimed at decreasing CO2 levels can ensure NIV success in SH-COPD. NIV initiated when patients remain hypercapnic whereas in a clinical stable state following an acute exacerbation can prolong the time to a readmission. Technological advances in NIV algorithms and remote monitoring have the potential to improve use and titration. NIV and portable NIV improve exercise tolerance and may accentuate the benefits derived from pulmonary rehabilitation alone. Summary Use of high-intensity NIV in SH-COPD is beneficial yet appropriate patient selection and implementation is paramount.

Effect of a combination of low-dose aminophylline and budesonide on lung function, serum inflammatory factors and quality of life of patients with chronic obstructive pulmonary disease

“…Moreover, lung function indices were markedly higher in the study group than in the control group. It has been that combination of low-dose aminophylline and budesonide was effective in improving pulmonary function of COPD patients [20]. Similar results were obtained in the present study.…”

Long‐term home non‐invasive ventilation in chronic hypercapnic chronic obstructive pulmonary disease patients: Real‐world impact on lung function, acute exacerbations and survival

“…12,16,19 Despite no difference was found when adjusting for age and 6MWT walking distance, our results demonstrate a better survival among patients who initiated H-NIV in a stable period compared with those whose H-NIV was initiated immediately after an AE, supporting the idea that H-NIV initiation is more advantageous among stable patients, as previous reports suggested. 19,40,41 More advanced disease, frequent exacerbations and consequent additional lung injury may explain the worse outcome among these patients, suggesting that may be a close monitoring of patients at high-risk of chronic hypercapnia would allow earlier intervention and, therefore, improve outcomes. [40][41][42] The 6MWT is a reliable assessment of functional exercise capacity in patients with COPD.…”

“…Adherence to therapy is of utmost importance concerning H-NIV efficacy, and our real-world data were similar to that reported on trials. 8,19 Although the optimal number of hours of use remains unknown, a meta-analysis suggests that a minimum use of 5 h per night is required to reach significant PaCO 2 changes after 3 months of treatment. 16 In our study, patients revealed a superior mean daily time which probably reflect both tolerability and the perception of clinical benefits.…”

Effect of Noninvasive Positive Pressure Ventilation on Prognosis and Blood Gas Level in COPD Patients Complicated with Respiratory Failure

“…Our experimental results identified lower PaCO 2 , higher PaO 2, and CaO 2 , as well as higher FEV1, FVC, and FEV1/FVC in the research group compared with the regular group after treatment, indicating that NIPPV can effectively improve the BG level and PF of COPD patients with RF based on routine treatment. e reason may be that while reducing the influence of airway resistance and energy consumption and promoting patients to recover spontaneous breathing function, NIPPV can increase ventilation volume and ventilation/blood flow ratio, maintain bronchiectasis, and strengthen air circulation to correct hypoxia and carbon dioxide retention, thus effectively improving BG indexes and PF [18,19]. In the study of Zheng et al [20], NIPPV also has a certain protective effect on BG analysis indexes of children after congenital heart disease surgery, mainly manifesting in significantly reduced PaCO 2 and obviously increased PaO 2 within 48 hours, similar to our study results.…”