Abstract
Recently, there has been increasing interest in the use of non invasive ventilation (NIV) to increase exercise capacity. In individuals with COPD, NIV during exercise reduces dyspnoea and increases exercise tolerance.Different modalities of mechanical ventilation have been used non-invasively as a tool to increase exercise tolerance in COPD, heart failure and lung and thoracic restrictive diseases. Inspiratory support provides symptomatic benefit by unloading the ventilatory muscles, whereas Continuous Positive Airway Pressure (CPAP) counterbalances the intrinsic positive end-expiratory pressure in COPD patients.Severe stable COPD patients undergoing home nocturnal NIV and daytime exercise training showed some benefits. Furthermore, it has been reported that in chronic hypercapnic COPD under long-term ventilatory support, NIV can also be administered during walking.Despite these results, the role of NIV as a routine component of pulmonary rehabilitation is still to be defined.
Highlights
During exercise in people with chronic obstructive pulmonary disease (COPD), expiratory flow limitation and increased respiratory frequency may reduce the expiratory time, resulting in increase in end-expiratory lung volume, a condition known as dynamic hyperinflation (DH)
An unavoidable physiological consequence of DH is an increase in the intrinsic positive end-expiratory pressure (PEEPi) and in the elastic work of breathing (WOB): the final result is severe dyspnoea during effort reducing the exercise tolerance [2,3]
This review describes the present state of the art on the use of non invasive ventilation (NIV) as a tool to increase the benefits of pulmonary rehabilitation
Summary
During exercise in people with chronic obstructive pulmonary disease (COPD), expiratory flow limitation and increased respiratory frequency may reduce the expiratory time, resulting in increase in end-expiratory lung volume, a condition known as dynamic hyperinflation (DH). An unavoidable physiological consequence of DH is an increase in the intrinsic positive end-expiratory pressure (PEEPi) and in the elastic work of breathing (WOB): the final result is severe dyspnoea during effort reducing the exercise tolerance [2,3]. There has been an increasing interest in the use of non invasive ventilation (NIV) to improve exercise capacity [6,7,8], based on the evidence that assisted ventilation, by unloading respiratory muscles, might allow patients to train at higher levels of exercise intensity.
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