Long-term effects of Noninvasive ventilation (NIV) on exacerbations rate and mortality in stable hypercapnic COPD patients

Abstract

<b>Background:</b> Although home NIV in stable hypercapinc COPD patients is suggested, the benefits of this intervention are still controversial. <b>Aims:</b> To investigate the effect of long-term NIV on the rate and severity of acute exacerbations, clinical symptoms and mortality in patients with hypercapnic COPD. <b>Methods:</b> NIV in the S/T mode was administered in stable hypercapnic COPD patients 3-4 weeks after admission for acute-on-chronic hypercapnic respiratory failure. Exclusion criteria were: a) BMI&gt;35 kg/m2, b) diagnosis or clinical suspicion of sleep breathing disorder, c) NIV intolerance or poor compliance. Number of exacerbations, arterial blood gases,COPD Assessment Test (CAT) and Medical Research Council (MRC) dyspnea scale were assessed before and 3 years after NIV initiation. Severe exacerbation was defined as hospitalization and moderate was defined as treatment with systemic corticosteroids and/orantibiotics. <b>Results:</b> 89 patients (74% men, mean age 69) were included. From baseline to 36 months, there was a significant improvement in moderate (1 vs 1.8, p=0.007) and severe exacerbations&nbsp;(0.4 vs 1.6, p=0.001), CAT score (p&lt;0.001), PO2 (p&lt;0.001), PCO2 (p&lt;0.001) and MRC scale (p&lt;0.001). Patients who responded positively to NIV were&gt;70 years, had higher PO2 at baseline (60 vs 51 mmHg) and lower prevalence of comorbidities compared to non responders. 28% of patients died, 6-40 months after NIV initiation. Patients with lower FEV1 and increased PCO2 at baseline were found to have a greater risk of death (p&lt;0.001). <b>Conclusions:</b> Early NIV in stable COPD patients seems to have beneficial&nbsp;effect on rate and severity of exacerbations, arterial blood gases and clinical&nbsp;symptoms.