One-year non-invasive ventilation in chronic hypercapnic COPD: Effect on quality of life

Abstract

The data on long-term application of non-invasive ventilation (NIV) in patients with chronic respiratory failure due to COPD are contradictory. We evaluated the effect of the addition of NIV to optimal treatment for 1 year on the quality of life of stable hypercapnic COPD patients. NIV was offered to 49 of 58 initially enrolled consecutive patients, of whom 22 refused NIV and comprised the standard treatment group whereas 27 received NIV. Quality of life was assessed with the SF-36 questionnaire. Additional measurements included blood gases, pulmonary function tests, dyspnea, daytime sleepiness, exacerbations and hospitalizations. The NIV group showed a significant improvement in quality of life in the third month, both in the Physical (31+/-4 to 38+/-8, p<0.0001) and the Mental Component Summary Score (28+/-7 to 40+/-10, p=0.009), that was maintained until the twelfth month. PaCO2 decreased by the first month in the NIV group (54+/-4.5 to 44.6+/-5.6 mmHg, p<0.0001), and PaO2 rose during the sixth month (58.9+/-5.7 to 64.4+/-6.5 mmHg, p=0.004). Dyspnea and diurnal sleepiness improved significantly. No significant improvements were observed in the control group. Patients on NIV spent less days in the hospital compared to controls. NIV when added to optimal medical treatment has beneficial effects on quality of life in stable hypercapnic COPD patients, with additional improvements in arterial blood gases, dyspnea and daytime sleepiness.

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

“…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.…”

“…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.…”

“…Only the first two outcomes are represented in Figures 6 and 7, based on eight RCTs (five 76,80,81,99,101 in stable and two 90,92 in post-hospital populations) and three controlled studies [93][94][95] (all stable populations). Severe exacerbations have been assumed to lead to hospitalisation and have been included in the hospitalisation analysis.…”

“…Around half of 80,90 or most 85 patients were on LTOT, with no details in two studies. 83,95 Given the sparsity of information, the uncontrolled studies were also considered. Only three studies (no restriction on sample size or length of follow-up) reported exacerbations.…”