COPD

NIV reduces COPD re-admissions


The addition of noninvasive ventilation to home oxygen and standard care following an exacerbation of COPD can reduce the risk of hospital readmission or death.

A multi-centre UK study recruited 116 patients with persistent hypercapnia (PaCO2 >53mmHg) and hypoxaemia (PaO2 <55mmHg) two to four weeks after an initial exacerbation.

The study, presented at the American Thoracic Society International Conference in Washington last week, found the addition of non-invasive ventilation (NIV) extended the time to readmission or death from 1.4 to 4.3 months.

Ventilation also reduced the number of exacerbations from 5.1 to 3.8 per year and the absolute risk of readmission or deaths in 12 months by 17%.

Health-related quality of life improved with ventilation but only at the 6-week and 3-month time points. All-cause mortality did not differ significantly between the ventilated and non-ventilated groups.

Commenting on the study, Professor Christine McDonald said the findings were of interest for the small number of COPD patients with severe end-stage disease and recurrent hospitalisations requiring non-invasive ventilation.

“More than 50% of the patients in this pragmatic UK study had at least three COPD-related admissions in the past year so they were recurrent presenters and a very severe group. The study provides a little support for home NIV in that situation,” she told the limbic in an interview.

Professor McDonald, director of respiratory and sleep medicine at Austin Health, said that every hospital admission was worth preventing given they were associated with significant morbidity and mortality.

“Perhaps we should ensure that when patients are reviewed at four weeks after hospitalisation with measurement of arterial blood gases, those who are persistently hypoxaemic and hypercapnic, have had recurrent exacerbations and are willing to try NIV, are given the opportunity to consider home ventilatory support.”

However not everyone was able to tolerate ventilation and there were additional barriers such as cost and complexity of use, she said.

The study provided no guidance on the duration of NIV but Professor McDonald said there would be a general reluctance to discontinue NIV if it appeared to be of benefit.

An editorial in JAMA agreed the findings supported the use of NIV ‘as long as patients with reversible hypercapnia are given sufficient time to recover (2-4 weeks after hospital discharge) and PaCO2 levels remain substantially elevated  (≥52mmHg)’.

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