Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD.
OBJECTIVE
To determine the 1-year efficacy of noninvasive positive pressure ventilation (NPPV) added to long-term oxygen therapy (LTOT) in patients with stable severe COPD. PATIENT SELECTION AND METHODS: We prospectively randomized 52 patients with severe COPD (FEV(1) < 45%) to either NPPV plus "standard care" (96% patients with LTOT) or to standard care alone (93% patients with LTOT). The outcomes measured included the following: rate of acute COPD exacerbations; hospital admissions; intubations; and mortality at 3 months, 6 months, and 12 months. The patients were also evaluated at 3 months and 6 months for dyspnea using the Medical Research Council and Borg scales, gas exchange, hematocrit, pulmonary function, cardiac function with echocardiogram, and neuropsychological performance.


RESULTS
One-year survival was similar in both groups (78%). The number of acute exacerbations was similar at all time points in patients receiving NPPV, compared with control subjects. The number of hospital admissions was decreased at 3 months in the NPPV group (5% vs 15% of patients, p < 0.05), but this difference was not seen at 6 months (18% vs 19%, respectively). The only beneficial differences were observed in the Borg dyspnea rating, which dropped from 6 to 5 (p < 0.039), and in one of the neuropsychological tests (psychomotor coordination) for the NPPV group at 6 months.


CONCLUSIONS
Our study indicates that over 1 year, NPPV does not affect the natural course of the disease and is of marginal benefit in outpatients with severe COPD who are in stable condition.
Casanova
C
C
Department of Pulmonary, Hospital La Candelaria, Department of Pulmonary and Internal Medicine, Hospital Universitario de Canarias, Tenerife, Spain.
Celli
B R
BR
Tost
L
L
Soriano
E
E
Abreu
J
J
Velasco
V
V
Santolaria
F
F
D000208:Acute Disease; D000368:Aged; D005500:Follow-Up Studies; D006439:Hemodynamics; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010102:Oxygen Inhalation Therapy; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D015656:Respiratory Mechanics; D015996:Survival Rate