Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: A randomized controlled trial

Marieke L Duiverman,Jan G Zijlstra,Gerrie Bladder,Johan B Wempe,Huib Am Kerstjens,Peter J Wijkstra,Judith M Vonk

doi:10.1186/1465-9921-12-112

Abstract

BackgroundThe use of noninvasive intermittent positive pressure ventilation (NIPPV) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure remains controversial as long-term data are almost lacking.The aim was to compare the outcome of 2-year home-based nocturnal NIPPV in addition to rehabilitation (NIPPV + PR) with rehabilitation alone (PR) in COPD patients with chronic hypercapnic respiratory failure.MethodsSixty-six patients could be analyzed for the two-year home-based follow-up period. Differences in change between the NIPPV + PR and PR group were assessed by a linear mixed effects model with a random effect on the intercept, and adjustment for baseline values. The primary outcome was health-related quality of life (HRQoL); secondary outcomes were mood state, dyspnea, gas exchange, functional status, pulmonary function, and exacerbation frequency.ResultsAlthough the addition of NIPPV did not significantly improve the Chronic Respiratory Questionnaire compared to rehabilitation alone (mean difference in change between groups -1.3 points (95% CI: -9.7 to 7.4)), the addition of NIPPV did improve HRQoL assessed with the Maugeri Respiratory Failure questionnaire (-13.4% (-22.7 to -4.2; p = 0.005)), mood state (Hospital Anxiety and Depression scale -4.0 points (-7.8 to 0.0; p = 0.05)), dyspnea (Medical Research Council -0.4 points (-0.8 to -0.0; p = 0.05)), daytime arterial blood gases (PaCO2 -0.4 kPa (-0.8 to -0.2; p = 0.01); PaO2 0.8 kPa (0.0 to 1.5; p = 0.03)), 6-minute walking distance (77.3 m (46.4 to 108.0; p < 0.001)), Groningen Activity and Restriction scale (-3.8 points (-7.4 to -0.4; p = 0.03)), and forced expiratory volume in 1 second (115 ml (19 to 211; p = 0.019)). Exacerbation frequency was not changed.ConclusionsThe addition of NIPPV to pulmonary rehabilitation for 2 years in severe COPD patients with chronic hypercapnic respiratory failure improves HRQoL, mood, dyspnea, gas exchange, exercise tolerance and lung function decline. The benefits increase further with time.Trial registrationClinicalTrials.Gov (ID NCT00135538).

Highlights

The use of noninvasive intermittent positive pressure ventilation (NIPPV) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure remains controversial as long-term data are almost lacking
We recently showed that the addition of 3-month nocturnal noninvasive intermittent positive pressure ventilation (NIPPV) to an intensive multidisciplinary rehabilitation program improves the outcomes of Pulmonary rehabilitation (PR) in severe COPD patients with chronic hypercapnic respiratory failure [5]
Our study shows for the first time that home-based NIPPV + PR provides long-term benefit as to health-related quality of life (HRQoL), mood state, dyspnea, gas exchange, exercise tolerance, and FEV1 over PR alone in patients with severe COPD with chronic hypercapnic respiratory failure

Summary

Introduction

The use of noninvasive intermittent positive pressure ventilation (NIPPV) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure remains controversial as long-term data are almost lacking. Pulmonary rehabilitation (PR) improves dyspnea, exercise capacity, and HRQoL in patients with COPD [2] These positive effects can be maintained well if the exercise training is continued at home after initial intensive PR [3]. We recently showed that the addition of 3-month nocturnal noninvasive intermittent positive pressure ventilation (NIPPV) to an intensive multidisciplinary rehabilitation program improves the outcomes of PR in severe COPD patients with chronic hypercapnic respiratory failure [5]. The present study explores whether the initial positive effects of 3month NIPPV in addition to PR, with the use of sufficient ventilator settings, can be maintained over 2-year home-based follow-up in COPD patients with chronic hypercapnic respiratory failure. Outcome parameters were HRQoL, mood state, dyspnea scores, gas exchange, functional status, pulmonary function, and exacerbation frequency

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