Domiciliary Non-invasive Ventilation Research Articles

Long-Term Mortality following Acute Noninvasive Ventilation for Obesity-Related Respiratory Failure: A Retrospective Single-Centre Study.

Determinants of long-term mortality following acute hypercapnic respiratory failure have been extensively studied in patients with chronic obstructive pulmonary disease. However, respiratory failure due to obesity has not been studied to the same extent. This retrospective survey aims to identify whether admission pH is associated with long-term mortality in patients requiring acute noninvasive ventilation (NIV) for obesity-related respiratory failure (ORRF). Records from April 2013 to March 2020 were accessed from a NIV quality database at an acute teaching hospital. Adults with hypercapnic ORRF requiring acute NIV were included. pH data were grouped by threshold (pH≤ and >7.25) and correlated with time from presentation to death; multivariable analysis was performed using Cox proportional hazards. A total of 277 acute NIV episodes were included. Two-year mortality was similar for patients in both pH categories. Univariable analysis identified pH ≤ 7.25 to increase risk of two-year mortality by 43%. However, multivariable analysis identified that pH was not a significant determinant of long-term mortality, although male sex, older age, and higher admission pCO2 increased the risk of death at two years by 76%, 3% per year of age, and 16% per 1 kPa of pCO2 increase, respectively. Severity of hypercapnia on admission, male sex, and older age are associated with worse two-year mortality in patients requiring acute NIV for ORRF. There is scope for further analyses including investigating the role of domiciliary NIV in ORRF patients.

Noninvasive Ventilation Automated Technologies: A Bench Evaluation of Device Responses to Sleep-Related Respiratory Events.

Noninvasive ventilation (NIV) is the reference standard treatment for most situations of chronic respiratory failure. NIV settings must be titrated to both preserve upper-airway patency and control hypoventilation. Automatic adjustment of pressure support (PS) and expiratory positive airway pressure (EPAP) may facilitate the initiation and follow-up of domiciliary NIV. However, whether the automatic-adjustment algorithms embedded into current devices accurately detect, respond to, and score common sleep-related respiratory events remains unclear. A bench was set up to simulate central hypopnea (CH), central apnea (CA), obstructive hypopnea (OH), and obstructive apnea (OA). Four home ventilators were evaluated, with their dedicated modes for automatic PS and EPAP adjustment. All 4 devices increased PS during CH, CA, and OH. However, PS adjustment varied widely in magnitude, with tidal volumes within 100 ± 20% of the target being provided by only 3 devices for CH, one for CA, and one for OH. Two devices increased EPAP for OH and 3 for OA, including one that also increased EPAP for CA. Only 2 devices scored residual hypopnea after simulated CA, and only one scored a residual event after OH. One device scored no event. Current NIV devices differed markedly in their responses to, and reporting of, standardized sleep-related respiratory events. Further improvements in embedded NIV algorithms are needed to allow more widespread out-of-laboratory initiation and follow-up of NIV.

Factors Affecting Domiciliary Non-Invasive Ventilation Compliance

Few international studies have investigated factors affecting domiciliary non-invasive ventilation (D-NIV) compliance, and data from the UK are limited. We assessed compliance (defined as ≥ 4 h/night for at least 70% of the time) in a retrospective UK population study, at three time points (0–1 month, 3–4 months and 11–12 months), for all patients commenced on D-NIV over a 5-year period. A total of 359 patients were included. Non-compliant vs. compliant patients were significantly younger (median age 64 (IQR 52–72) vs. 67 (58–75) years, p = 0.032) and more likely to have schizophrenia, consistent at both 3–4 months (5% vs. 1%, p = 0.033) and 11–12 months (5% vs. 2%, p = 0.049). Repeated measures ANOVA demonstrated that the minutes [median (IQR)] of D-NIV used significantly increased at the three time points (0–1 month, 3–4 months and 11–12 months) for patients with hypertension [310 (147.5–431) vs. 341 (89–450) vs. 378 (224.5–477.5), p = 0.003]; diabetes [296.5 (132.5–417.5) vs. 342.5 (94.5–438.5) vs. 382 (247.5–476.25), p = 0.002] and heart failure [293 (177–403) vs. 326 (123–398) vs. 365 (212–493), p = 0.04]. In conclusion, younger and comorbid schizophrenic patients have lower D-NIV compliance rates, and our data suggest that persistence with D-NIV over a year may improve overall use.

Non-invasive ventilation in neuromuscular diseases: should we use higher levels of ventilatory support?

In patients with COPD, one of the leading indications for domiciliary non-invasive ventilation (NIV), a major paradigm shift has been observed over the past decade in the method for adjusting NIV settings, with the use of sufficient ventilatory support to achieve a significant reduction in PaCO2. Whether this approach may be relevant to other populations, especially slowly progressive neuromuscular diseases (NMD), is unknown. This study was conducted as a post hoc analysis from a previously published randomized controlled trial (NCT03458507). Patients with NMD treated with domiciliary NIV were stratified according to the level of ventilatory support: high-level tidal volume (HLVT; mL/kg of predicted body weight [PBW]) or high-level pressure support (HLPS), defined as a value above median value of the whole population (> 6.8mL/kgPBW or 9.0 cmH2O, respectively). Primary outcome was mean nocturnal transcutaneous CO2 pressure (PtcCO2). Secondary outcomes included adherence to NIV, leaks, and side effects. Of a total of26 patients, 13 were exposed to HLVT, with significantly lower nocturnal PtcCO2 (respectively 40.5 ± 4.2 vs. 46.3 ± 3.9mmHg, p = 0.002). A linear correlation between VT (mL/kgPBW) and mean nocturnal PtcCO2 was evidenced (r = - 0.59, 95%CI [- 0.80; - 0.25], p = 0.002). No significant impact of HLVT was found on secondary outcomes. Despite the lack of power of this post hoc analysis, our results suggest that higher levels of ventilatory support are correlated with lower PtcCO2 in patients with NMD. Further studies are desirable to assess the extent to which the level of assistance influences PaCO2 evolution in patients with slowly progressive NMD, as well as in restrictive thoracic disorders.

Hypercapnia in COPD: Causes, Consequences, and Therapy.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder that may lead to gas exchange abnormalities, including hypercapnia. Chronic hypercapnia is an independent risk factor of mortality in COPD, leading to epithelial dysfunction and impaired lung immunity. Moreover, chronic hypercapnia affects the cardiovascular physiology, increases the risk of cardiovascular morbidity and mortality, and promotes muscle wasting and musculoskeletal abnormalities. Noninvasive ventilation is a widely used technique to remove carbon dioxide, and several studies have investigated its role in COPD. In the present review, we aim to summarize the causes and effects of chronic hypercapnia in COPD. Furthermore, we discuss the use of domiciliary noninvasive ventilation as a treatment option for hypercapnia while highlighting the controversies within the evidence. Finally, we provide some insightful clinical recommendations and draw attention to possible future research areas.

The Factors Related to the 6 Minute Walk Test: The Experience of a Referral Lung Transplantation Center

Objectives: The 6-minute-walk test is a practical and widely used test, which indicates the exercise capacity in patients with a severe pulmonary disease. The study aims to investigate the related factors with the 6-minute-walk test in lung transplantation candidates.
 Materials and Method: The data were collected retrospectively from 349 patients, between January 2012 and September 2020. The patients were grouped according to their underlying lung disease as obstructive lung diseases, interstitial lung diseases, and infective lung diseases. The data collected included patient demographics, gender, body mass index, artery blood gas, the results of the respiratory function test, six-minute walk test, long-term oxygen therapy, and the need for non-invasive mechanical ventilation [such as group 1 (6MWD<200) and group 2(6MWD≥200)]. All of the collected data were analyzed and compared between the groups.
 Results: Overall, 349 patients were included in the study, and there were 123 females and 226 males (35.2% and 64.8% respectively) with a mean age of 46.92 ± 14.1 years. Their mean body mass index was 23.58 ± 12.52 kg/m2, the median FEV1(%) was 35.3 (33.4-37.2), the median six-minute walk distance was 222 m (125-335 m), and the mean PaO2/FiO2 (P/F) was 250.32% ± 74.81, the mean PCO2 was 45.71 mmHg ± 11.97. Furthermore, the patients using long-term oxygen therapy were (n=274, 78.5%) and non-invasive mechanical ventilation were (n=125, 35.8%). The mortality status, P/F, long-term oxygen therapy usage, and non-invasive mechanical ventilation usage were different between Group 1 and Group 2 (p=0.001, p=0.001, p<0.001, and p<0.001, respectively). There was no difference between the groups in patients with and without IPF between underlying diseases. The 6-minute walk test was found to have moderate correlation with FEV1 and P/F; and a negative correlation with age and PCO2 (p<0.01, r=0.33.8, p<0.001, r= 38.1 and p=0.17, r=12,7, p<0.001, r=-0.30.6, respectively). There was no correlation between P/F, FEV1, and body mass index; and also, between PCO2, age, and body mass index. Age had a weak correlation with FEV1(p<0.001, r=19.3). There was no correlation between the age and 6MWD, as well as P/F, PCO2, and the body mass index. The factors affecting survival in multivariate analysis were investigated by using the Cox regression model. It was observed that gender (OR, 0.001; 95% CI, 0.246-0.716; p=0.42), FEV1(OR, 1.02; 95% CI, 1.00-1.04; p<0.001), P/F (OR, 1.00; 95% CI, 1.00-1.01; p<0.001), and LTOT (OR, 9.83; 95% CI, 3.70-26.14; p<0.001) were independent factors associated with 6MWD<200 m.
 Conclusion: The 6-minute walk test is associated with mortality, gender, poor oxygenation, and with the utilization of domiciliary non-invasive mechanical ventilation or long-term oxygen therapy. Furthermore, it is an independent risk factor for mortality in lung transplant candidates and in providing a valuable method for the management of patients.

Cost-effectiveness of domiciliary non-invasive ventilation in patients with chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic disease associated with recurring exacerbations, which influence morbidity and mortality for the patient, while placing significant resource burdens on healthcare systems. Non-invasive...

The Long-term Efficacy of Domiciliary Noninvasive Positive-Pressure Ventilation in Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials.

BackgroundWe evaluated the long-term effects of domiciliary noninvasive positive-pressure ventilation (NIPPV) used to treat patients with chronic obstructive pulmonary disease (COPD).MethodsDatabases were searched to identify randomized controlled trials of COPD with NIPPV for longer than 1 year. Mortality rates were the primary outcome in this meta-analysis. The eight trials included in this study comprised data from 913 patients.ResultsThe mortality rates for the NIPPV and control groups were 29% (118/414) and 36% (151/419), suggesting a statistically significant difference (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65–0.95). Mortality rates were reduced with NIPPV in four trials that included stable COPD patients. There was no difference in admission, acute exacerbation and quality of life between the NIPPV and control groups. There was no significant difference in withdrawal rates between the two groups (RR, 0.99; 95% CI, 0.72–1.36; p=0.94).ConclusionMaintaining long-term nocturnal NIPPV for more than 1 year, especially in patients with stable COPD, decreased the mortality rate, without increasing the withdrawal rate compared with long-term oxygen treatment.

Respirační insuficience, chronická hyperkapnie a domácí neinvazivní ventilace z pohledu pneumologa

Domiciliary non-invasive ventilation has been an established method of treating chronic hypercapnic respiratory insufficiency for decades. Its effectiveness is based on a number of clinical studies and the prevalence of use worldwide and in the Czech Republic is increasing. The article offers a brief summary of the pathophysiology of hypercapnic respiratory insufficiency and its treatment.

Efficacy of domiciliary noninvasive ventilation on clinical outcomes in posthospital chronic obstructive pulmonary disease patients: a meta-analysis of randomized controlled trials.

As newly emerging evidence was given, we conducted a meta-analysis of randomized controlled trials (RCTs) with the following objectives: (I) to evaluate the effect of long-term noninvasive ventilation (NIV) on posthospital chronic obstructive pulmonary disease (COPD) patients with respiratory failure in mortality, blood gas, exacerbation frequency; (II) to distinguish different follow-up length of long-term NIV and its effect on these outcomes. We tried to conduct and report this meta-analysis in accordance with the Cochrane Handbook (version 5.1.0) by searching the PubMed, Embase, Cochrane Library, and Chinese Biomedical Literature for RCTs in humans through April 2020. Studies comparing treatment effects of domiciliary NIV with control therapy in posthospital COPD patients were conducted, and at least one of the following parameters were reviewed: mortality, gas exchange, and exacerbation frequency. Five studies with 419 subjects were identified. The exacerbation frequency significantly decreased in patients who received domiciliary NIV [weighted mean difference (WMD) -1.74, 95% CI: -2.90 to -0.57, P=0.004]. No significant difference was found in mortality, partial pressure of arterial oxygen (PaO2), PaCO2, and pH. Subgroup analysis of PaCO2 showed that domiciliary NIV of 3 months was most likely to decrease PaCO2, but not significant (WMD -2.95, 95% CI: -6.11 to 0.21, P=0.07). The results indicate that domiciliary NIV decreases the exacerbation frequency of posthospital COPD patients, but may not improve mortality or gas exchange. Further studies are needed to evaluate the benefit of domiciliary NIV on COPD patients.

Chronic obstructive pulmonary disease exacerbation fundamentals: Diagnosis, treatment, prevention and disease impact.

In chronic obstructive pulmonary disease (COPD), exacerbations (ECOPD), characterized by an acute deterioration in respiratory symptoms, are fundamental events impacting negatively upon disease progression, comorbidities, wellbeing and mortality. ECOPD also represent the largest component of the socioeconomic burden of COPD. ECOPDs are currently defined as acute worsening of respiratory symptoms that require additional therapy. Definitions that require worsening of dyspnoea and sputum volume/purulence assume that acute infections, especially respiratory viral infections, and/or exposure to pollutants are the main cause of ECOPD. But other factors may contribute to ECOPD, such as the exacerbation of other respiratory diseases and non-respiratory diseases (e.g., heart failure, thromboembolism). The complexity of worsening dyspnoea has suggested a need to improve the definition of ECOPD using objective measurements such as blood counts and C-reactive protein to improve accuracy of diagnosis and a personalized approach to management. There are three time points when we can intervene to improve outcomes: acutely, to attenuate the length and severity of an established exacerbation; in the aftermath, to prevent early recurrence and readmission, which are common, and in the long-term, establishing preventative measures that reduce the risk of future events. Acute management includes interventions such as corticosteroids or antibiotics and measures to support the respiratory system, including non-invasive ventilation (NIV). Current therapies are broad and better understanding of clinical phenotypes and biomarkers may help to establish a more tailored approach, for example in relation to antibiotic prescription. Other unmet needs include effective treatment for viruses, which commonly cause exacerbations. Preventing early recurrence and readmission to hospital is important and the benefits of interventions such as antibiotics or anti-inflammatories in this period are not established. Domiciliary NIV in those patients who are persistently hypercapnic following discharge and pulmonary rehabilitation can have a positive impact. For long-term prevention, inhaled therapy is key. Dual bronchodilators reduce exacerbation frequency but in patients with continuing exacerbations, triple therapy should be considered, especially if blood eosinophils are elevated. Other options include phosphodiesterase inhibitors and macrolide antibiotics. ECOPD are a key component of the assessment of COPD severity and future outcomes (quality of life, hospitalisations, health care resource utilization, mortality) and are a central component in pharmacological management decisions. Targeted therapies directed towards specific pathways of inflammation are being explored in exacerbation prevention, and this is a promising avenue for future research.

Non-invasive ventilation in the elderly - never too late!

Dear Editor, Practising evidence-based medicine in an ageing population is challenging. Nevertheless, using age as a diagnostic or therapeutic procedure contraindication is less and less common. Domiciliary non-invasive ventilation (NIV) in chronic respiratory failure patients has been largely used; however, data from older people is scarce...

Morphine in acute chronic obstructive pulmonary disease exacerbation

A 58-year-old man, awaiting lung transplantation, was admitted to our hospital with severe acute exacerbation of chronic obstructive pulmonary disease (COPD). He had been treated with supplemental oxygen and domiciliary...

Difficulties experienced by geriatric patients regarding respiratory devices and access to health services: A cross-sectional study

Background/Aim: In the treatment of chronic respiratory failure, long-term oxygen therapy at home (LTOT) and domiciliary noninvasive mechanical ventilation (NIV) are important components of home care. The aim was to evaluate the compliance of geriatric patients with LTOT/NIV at home and their access to health services in the last year. Methods: Screening of 669 patients who were hospitalized in our pulmonary intensive care unit between 30.09.2019 and 30.09.2020 revealed a total of 109 patients over 80 years of age with chronic respiratory failure. Among them, 70 died after discharge. Six of the 39 surviving cases were excluded from the study because they were discharged without any LTOT and/or NIV devices, and the COVID-19 PCR tests of 4 patients were positive after discharge. The remaining 29 patients over 80 years of age were enrolled in the study. After questioning the patient's care status, caregivers were asked whether the patients were compliant with NIV and/or LTOT devices at home and their usage in terms of hours during the day and nighttime. In non-compliant patients, the reasons were acquired, and the answers were noted. They were asked whether they gave up on healthcare services and scheduled check-ups, had difficulties in getting a doctor's appointment, and whether they were incompliant with the appointments they made. If the answers were yes, they asked about their reasons for each question. Results: The median age was 85 (80-96) years, and 65.5% (n=19) of the cases were female. The diagnosis which led to hospitalization in 86.2% (n=25) of the patients was hypercapnic respiratory failure. Fifteen patients (51.7%) with LTOT and 9 patients (81.8%) with NIV did not use their devices as recommended. The patients' caregivers expressed that 22 patients (75.8%) could not meet their basic needs and 17 patients (77.2%) did not receive home care services provided by the Ministry of Health. Although the need arose in the post-discharge period, it was observed that 24 patients (82.7%) were not taken to the doctor and 20 patients (68.9%) did not schedule doctor visits after discharge. All caregivers stated that they were afraid of the COVID-19 pandemic and catching the COVID-19 disease from the emergency rooms and outpatient clinics. Conclusions: Our patients' compliance with the LTOT device was poor and 51.7% of the patients used the device less than recommended. Moreover, the patients were mostly incompliant with domiciliary NIV treatment. Receiving nonspecific home care services did not have any effect on LTOT and/or NIV compliance. It was observed that disruption in doctor visits and patient admissions leads to the decreased compliance with LTOT and/or NIV devices and loss of motivation to use these devices. The cases in this study avoided all kinds of admissions to the hospital due to the COVID-19 pandemic. In such conditions, structured and specific home care services for geriatric respiratory failure patients become more important. Continuing education and motivation at home will increase the quality of life of the patients and improve compliance.

The Effects of Low Pressure Domiciliary Non-Invasive Ventilation on Clinical Outcomes in Patients with Severe COPD Regardless Having Hypercapnia.

BackgroundThe effectiveness of non-invasive home ventilation in patients with severe chronic obstructive pulmonary disease (COPD) is lacking. Non-invasive home ventilation might be more effective when high ventilator settings are used. However, high ventilator settings might reduce patient adherence. We have developed a multidisciplinary approach (ventilation practitioners, 24 hours support of respiratory nurses, physicians) to non-invasive ventilation aimed at optimizing patient adherence using low ventilator settings in severe COPD patients with high disease burden irrespectively having hypercapnia.MethodsWe included in a proof of concept, prospective interventional study, 48 GOLD stage III–IV COPD patients with a high disease burden (≥2 exacerbations in a year, and Medical Research Council dyspnea scores ≥3). Outcome measures included hospital admissions, capillary pCO2, Medical Research Council dyspnea scores (MRC), Clinical COPD Questionnaire scores (CCQ) and Hospital Anxiety and Depression Scale (HADS).ResultsAfter 1 year 32 patients could be evaluated. Hospital admissions decreased by 1.0 admission (mean difference ± SD: 1.0 ± 1.48; p = 0.001). In-hospital days decreased by 10.0 days (10.0 ± 15.48; p = 0.001). Capillary pCO2 decreased by 0.33 kPa (0.33 ± 0.81: p = 0.03). The MRC dyspnea score decreased by 0.66 (0.66 ± 1.35; p = 0.02). The CCQ score decreased by 0.59 (0.59 ± 1.39; p = 0.03). The HADS anxiety score decreased by 1.64 (1.64 ± 3.12; p = 0.01). The HADS depression score decreased by 1.64 (1.64 ± 3.91; p = 0.04).ConclusionA proof of concept multidisciplinary approach, using low pressure domiciliary non-invasive ventilation, aimed at optimizing patient adherence in severe COPD patients regardless having hypercapnia, reduced hospital admissions and improved symptoms and quality of life measures. This may imply that severe COPD patients with high disease burden, irrespective being hypercapnic, are candidates to be treated with low pressure domiciliary non-invasive ventilation.

Nocturnal non invasive ventilation in normocapnic cystic fibrosis patients: a pilot study.

Background and aim:In patients with cystic fibrosis (CF) non-invasive ventilation (NIV) improves lung mechanics and gas exchange, and decreases the work of breathing. Domiciliary NIV is mainly used in hypercapnic patients with severe disease, because it counteracts the progression of lung functional impairment and it is often used as a useful “bridge” to lung transplantation. However, to date, there are no standardized criteria to indicate the effect of a precocious starting of NIV in patients with functional ventilation inhomogeneity without hypercapnia. In this pilot study we assessed whether an early NIV treatment might influence functional and clinical outcomes in CF patients.Methods:Six normocapnic CF patients were treated for one year with NIV. At baseline and after 1 year of NIV treatment, arterial gas analysis, spirometry, MBW to derive LCI, nocturnal cardio-respiratory polygraphy (PG), and Pittsburgh Sleep Quality Index (PSQI) were perfomed in all enrolled patients.Results:After one year, despite spirometric and LCI values remain statistically not modified, the number of infectious exacerbations was reduced by 50%.Conclusions:These results suggest that nocturnal NIV improves clinical conditions of stable CF patients. Finally, we suggest that this procedure can be useful to counteract the progression of lung disease even in normocapnic patients (www.actabiomedica.it)

Is there enough room for non-invasive ventilation in pulmonary rehabilitation?

Pulmonary rehabilitation (PR) is a non-pharmacological intervention addressed to chronic obstructive pulmonary disease (COPD) and non-COPD chronic respiratory patients, a key management strategy scientifically demonstrated to improve exercise capacity, dyspnoea, health status and psychological wellbeing. The main body of literature comes from COPD patients, as they provide the core evidence for PR programmes. PR is recommended even to severe patients having chronic respiratory failure; their significant psychological impairment and potential for greater instability during the PR programme will be carefully considered by the multidisciplinary team. Optimizing medical management (e g, inhaled bronchodilators, oxygen therapy, non- invasive ventilation) may enhance the results of exercise training. Patients who already receive long-term domiciliary non- invasive ventilation (NIV) for chronic respiratory failure might exercise with NIV during exercise training if acceptable and tolerable to the patient. It is not advisable to offer long-term domiciliary NIV with the only aim to improve outcomes during PR course. There are different attempts to use both negative and positive NIV in limited clinical studies. Long-term adherence to exercise is an important goal of PR programmes and teams, targeting to translate all-domain gains of PR into increased physical activity and participation to real life. Being a reliable alternative for the future, studies should focus on pressure regimens, type of devices, acceptability and portability for everyday activities.

Extracorporeal CO2 removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: a proof-of-concept study

Domiciliary non-invasive ventilation (NIV) effectively reduces arterial carbon dioxide pressure (PaCO2) in patients with stable hypercapnic chronic obstructive pulmonary disease, but a consistent percentage of them may remain hypercapnic. We...

Experiences and views of patients, carers and healthcare professionals on using modems in domiciliary non-invasive ventilation (NIV): a qualitative study

BackgroundAdvances in technology means that domiciliary non-invasive ventilation (NIV) devices can be remotely monitored via modems in patients’ homes. Possible benefits and challenges of modem technology have yet to be...

A Low-Cost Breath Analyzer Module in Domiciliary Non-Invasive Mechanical Ventilation for Remote COPD Patient Monitoring.

Smart Breath Analyzers were developed as sensing terminals of a telemedicine architecture devoted to remote monitoring of patients suffering from Chronic Obstructive Pulmonary Disease (COPD) and home-assisted by non-invasive mechanical ventilation via respiratory face mask. The devices based on different sensors (CO2/O2 and Volatile Organic Compounds (VOCs), relative humidity and temperature (R.H. & T) sensors) monitor the breath air exhaled into the expiratory line of the bi-tube patient breathing circuit during a noninvasive ventilo-therapy session; the sensor raw signals are transmitted pseudonymized to National Health Service units by TCP/IP communication through a cloud remote platform. The work is a proof-of-concept of a sensors-based IoT system with the perspective to check continuously the effectiveness of therapy and/or any state of exacerbation of the disease requiring healthcare. Lab tests in controlled experimental conditions by a gas-mixing bench towards CO2/O2 concentrations and exhaled breath collected in a sampling bag were carried out to test the realized prototypes. The Smart Breath Analyzers were also tested in real conditions both on a healthy volunteer subject and a COPD suffering patient.