Abstract
The long-term effect of average volume-assured pressure support (AVAPS) on health-related quality of life (HRQOL) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure (CHRF) remains unclear.The objective of this study is to identify the long-term effect of AVAPS in COPD patients with CHRF through assessment of HRQOL, exercise tolerance after six months duration.MethodsIn this randomized, controlled, parallel-group study, 40 stable hypercapnic COPD patients were randomized in a 1:1 ratio to receive either spontaneous timed AVAPS (ST/AVAPS) (intervention) or Bilevel positive airway pressure (ST/BiPAP) (control). HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12). Exercise tolerance assessed by 6 min walking distance. Analyses were done between groups from baseline to the average of six months measurements.ResultsAVAPS led to significant 6 months improvements in several domains of (SF-12) compared to the control group, with the greatest improvement seen in general health [treatment effect of 8.2 points (95% confidence interval [95% CI 3.2 to 11.7; p = 0.001)], vitality (treatment effect 5.4 points [95% CI 1.4 to 9.3]; p = 0.001), physical functioning 5.5 points [95% CI 1.1 to 9.8]; p = 0.001) and bodily pain 5.1 points [95% CI 3.4 to 8.8]; p = 0.002). The physical health summary score improved by 3.7 points (95% CI 1.2 to 5.8; p = 0.001), but no significant improvement in the emotional or social role functioning, mental health subscale was noted.AVAPS also resulted in improvement 6 min walking distance 9.2 points (95% CI − 1 to − 15];p = 0.001). A significant reduction in the daytime (PaCO2) was observed after 6 months in those treated with AVAPS.ConclusionsIn COPD patients with hypercapnic respiratory failure, AVAPS improved exercise tolerance and multiple domains of HRQOL over six months of follow-up, with the significant improvement observed in general health.
Highlights
Chronic obstructive pulmonary disease (COPD) is a chronic disease with higher mortality and morbidity worldwide
The purpose of this study was to attempt to determine the positive outcomes of average volume assured pressure support (AVAPS) in stable hypercapnic COPD patients through assessment of daytime Partial arterial carbon dioxide pressure (PaCO2) levels, exercise tolerance, the effect on the quality of life measures
A total of 40 patients with stable COPD and chronic hypercapnic respiratory failure were screened as outpatients and randomized when they met all inclusion criteria, and subsequently planned for non-invasive positive pressure ventilation (NiPPV) initiation either with ST/AVAPS) and ST/BiPAPgroup
Summary
Chronic obstructive pulmonary disease (COPD) is a chronic disease with higher mortality and morbidity worldwide. Patients with end-stage COPD frequently develop chronic hypercapnic respiratory failure (CHRF) associated with end-of-life. In this stage of the disease, patients experience extremely disabling symptoms of dyspnoea, increased risk for frequent exacerbations, re-hospitalization leading to severely impaired health-related quality of life (HRQOL), with limited treatment options [1]. Evidence to support interventions for the treatment of chronic respiratory failure in COPD, except for the use of long-term oxygen therapy (LTOT), has been lacking. NiPPV is commonly instituted in COPD patients with hypercapnia during hospitalization for acute exacerbations and subsequently continued as an outpatient sporadically. The evidence to support this intervention is conflicting with no consistent benefit in survival, need for re-hospitalization, clinical impact, quality of life, sleep efficiency or 6 min walk distance [3]
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