P219 The use of oral modafinil in chronic obstructive pulmonary disease patients with chronic hypercapnic respiratory failure

Abstract

Hypercapnic respiratory failure (HRF) is common in advanced COPD. The standard treatment is usually nasal ventilation (NIV) to reduce the blood carbon dioxide level acutely or regular nocturnal use in chronic cases. Not all patients tolerate such treatment and failures occur. Published studies are conflicting showing variable benefit and a 2013 Cochrane review concluded that there was no evidence of significant benefit in any of the measured parameters.1 Other studies suggest a reduction in re-admission and death at 1 year between regular nocturnal NIV use and standard care.We have used oral modafinil 200 mg/day as a respiratory stimulant for chronic HRF in COPD without NIV. We present the data from the first 11 cases (6 out of study and 7 in our current open randomised crossover study). The study patients had documented HRF for 6–12 months with PaC02 ≥6.5 before entry but refused NIV. We present the data at baseline and day 10 and 40 of modafinil, including mean arterial oxygen and carbon dioxide, Daytime and overnight oxygen saturations along with spirometry. We compare these Results with 2 published studies of NIV reported, one after 4 weeks2 and the other 12 months.3 The study showed a mean improvement by day 40 of +1.8 kPa in Pa02 and a reduction in PaCO2 by 2.7 kPa. Daytime saturations, improved by +15% and overnight saturations by +11%. FEV-1 and FVC improved by +4%–5% which may reflect reduced acidosis on ventilatory muscles. Compared with studies of nocturnal nasal ventilation, modafinil equalled the effects of NIV and tolerance was excellent. It could provide a cheaper and more effective alternative for patient unable to use long term NIV in HRF.Abstract P219 Table 1Study Datan=11BaselinePre-modafinil Day 10 modafinil200 mg/dayDay 40Modafinil200 mg/dayImprovementAt 40 days4 week NIV2ImprovementAfter 4 weeksOf NIV1 year study ofNIV 3ImprovementAt 1 year Mean ArterialPa02 kPaOn air (range)5.8(4.3–7.3)6.7(4.1–8.1)7.67(5.5–9.3)+1.87 kPa7.5 +1.7 7.0+2.4Mean ArterialPaC02 kPaOn air(range)8.6(6.5–13.4)6.7(5.2–8.0)5.9(5.0–6.3)−2.7 kPa7.5 −0.7 7.2−1.35Mean daytime saturations on air (range)75%(58–89)85%(65–92)90%(79–95)15%No dataNo dataNo dataNo dataMean overnight saturations on air(range)72%(58–86)79%(67–89)83%(68–91)+11%79%0%No dataNo dataMeanFEV-1 (%)28%30%32%+4%31%+6%25%−1%MeanFVC (%)48%45%53%+5%No dataNo data54%No dataReferencesN S Hill. JAMA on line21may, 2017.P Sivasothy. ERJ 1998;11:34–40.RD McEvoy. Thorax2009;64:561–566.