Home noninvasive ventilation with oxygen therapy effective for COPD and hypercapnia

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Adding home noninvasive ventilation to home oxygen therapy was effective in patients with persistent hypercapnia following an acute exacerbation of COPD.
Adding home noninvasive ventilation to home oxygen therapy was effective in patients with persistent hypercapnia following an acute exacerbation of COPD.

The addition of home noninvasive ventilation to home oxygen therapy prolonged the time to readmission or death within 12 months in patients with persistent hypercapnia following an acute exacerbation of chronic obstructive pulmonary disease (COPD), according to data published in JAMA.

Patrick B. Murphy, PhD, from St. Thomas' Hospital in London, and colleagues conducted a randomized clinical trial that included 116 patients with persistent hypercapnia 2 to 4 weeks after resolution of respiratory acidemia. The participants were recruited from 13 centers in the United Kingdom between 2010 and 2015.

A total of 59 participants were randomly assigned to receive home oxygen alone (median oxygen flow rate, 1.0 L/min) and 57 patients were assigned to home oxygen plus home noninvasive ventilation (median oxygen flow rate, 1.0 L/min). The median home ventilator settings were an inspiratory positive airway pressure of 24 cm H2O, an expiratory positive airway pressure of 4 cm H2O, and a backup rate of 14 breaths per minute. Twenty-eight participants who received home oxygen alone and 36 participants who received home oxygen plus home noninvasive ventilation completed the 12-month study.

The researchers found that the median time to readmission or death was 4.3 months among those who received home oxygen plus home noninvasive ventilation compared with 1.4 months among those who received home oxygen alone (adjusted hazard ratio, 0.49).

The results showed that the 12-month risk of readmission or death was 63.4% in the group receiving home oxygen plus home noninvasive ventilation compared with 80.4% in the group receiving home oxygen alone (absolute risk reduction, 17.0%).  In addition, at 12 months, 16 patients had died in the group that received home oxygen plus home noninvasive ventilation compared with 19 in the group receiving home oxygen alone.

“These data support the screening of patients with COPD after receiving acute noninvasive ventilation to identify persistent hypercapnia and introduce home noninvasive ventilation,” the researchers concluded.

In an accompanying editorial, Nicholas Hill, MD, from Tufts Medical Center, and Aylin Ozsancak Ugurlu, MD, from Baskent University in Istanbul, Turkey, note that considering home oxygen with home noninvasive ventilation should be considered as long as patients with reversible hypercapnia are given 2 to 4 weeks to recover after hospital discharge. In addition, PACO2 levels should remain elevated above 52 mm Hg.

“After all the conflicting evidence accrued to date, more studies are needed to confirm recent findings and to better define patient characteristics (including presence of sleep-disordered breathing) and technical aspects that will optimize chances of success of home [noninvasive ventilation] for patients with COPD,” they wrote.

References

  1. Hill NS, Ugurlu AO. Home noninvasive ventilation to reduce readmissions for chronic obstructive pulmonary disease. JAMA. 2017;317(21):2167-2169. doi:10.1001/jama.2017.5226
  2. Murphy PB, Rehal S, Arbane G, et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: A randomized clinical trial. JAMA. 2017;317(21):2177-2186. doi:10.1001/jama.2017.4451
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