Randomized controlled trial of home noninvasive positive pressure ventilation plus breathing exercises in patients with stable severe chronic obstructive pulmonary disease

Abstract

Objective To study the effects of home noninvasive positive pressure ventilation (HNPPV) plus breathing exercises actualized on the patients with stable severe chronic obstructive pulmonary disease (COPD). Methods Fifty-six patients with stable severe COPD after hospital discharge were randomized divided into 2 groups: the therapy group (n = 26) with breathing exercises and HNPPV,and the control group ( n = 30) with HNPPV. Parameters before and after 2 year follow up observation were compared, which included arterial partial pressure of carbon dioxide (PaCO2), pulmonary function,6-min walking distance (6MWD), dyspnea grade, scale for accessory muscle use, hospitalization rates and mortality. Results The age,gender, course of disease, body mass index, arterial PaCO2, PaO2,forced expiratory volume in one second ( FEV1 % pred), FEV1/FVC%, 6MWD, dyspnea grade, scale for accessory muscle use,and hospitalization rates of the 2 groups were similar. After 2 years,the difference of dyspnea grade,scale for accessory muscle use,6MWD and hospitalization rates in the therapy group was statistically significant compared to the control group[(1. 76±0.52) vs (2.09±0. 57)、(2. 44±0.62) vs(2.96±0.58) 、(262.64±32.98) m vs (244. 25±25.83) m、(2.06±0.85) times/year vs (2.62±0.92)times/year] (all P ＜ 0.05). The mortality had no statistically significant difference (1/26, 2/30,respectively, x 2 = 0.02). Conclusions HNPPV plus breathing exercises with stable severe COPD is effective and safe. Key words: Pulmonary disease, chronic obstructive; Noninvasive positive pressure ventilation; Home mechanical ventilation ; Respiratory insufficiency; Hypercapnia; Breathing exercises