title: Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD.
abstract: BACKGROUND
  Long-term non-invasive positive pressure ventilation (NIPPV) might improve the outcomes of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure. A study was undertaken to investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation improves health-related quality of life, functional status and gas exchange compared with pulmonary rehabilitation alone in patients with COPD with chronic hypercapnic respiratory failure.
  
  
  METHODS
  72 patients with COPD were randomly assigned to nocturnal NIPPV in addition to rehabilitation (n = 37) or rehabilitation alone (n = 35). Outcome measures were assessed before and after the 3-month intervention period.
  
  
  RESULTS
  The Chronic Respiratory Questionnaire total score improved 15.1 points with NIPPV + rehabilitation compared with 8.7 points with rehabilitation alone. The difference of 7.5 points was not significant (p = 0.08). However, compared with rehabilitation alone, the difference in the fatigue domain was greater with NIPPV + rehabilitation (mean difference 3.3 points, p<0.01), as was the improvement in the Maugeri Respiratory Failure questionnaire total score (mean difference -10%, p<0.03) and its cognition domain (mean difference -22%, p<0.01). Furthermore, the addition of NIPPV improved daytime arterial carbon dioxide pressure (mean difference -0.3 kPa; p<0.01) and daily step count (mean difference 1269 steps/day, p<0.01). This was accompanied by an increased daytime minute ventilation (mean difference 1.4 l; p<0.001).
  
  
  CONCLUSIONS
  Non-invasive ventilation augments the benefits of pulmonary rehabilitation in patients with COPD with chronic hypercapnic respiratory failure as it improves several measures of health-related quality of life, functional status and gas exchange.
authors: Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Post Box 30001, 9700 RB Groningen, The Netherlands. m.l.duiverman@int.umcg.nl
authors: M L
authors: ML
authors: Duiverman
authors: J B
authors: JB
authors: Wempe
authors: G
authors: G
authors: Bladder
authors: D F
authors: DF
authors: Jansen
authors: H A M
authors: HA
authors: Kerstjens
authors: J G
authors: JG
authors: Zijlstra
authors: P J
authors: PJ
authors: Wijkstra
mesh_terms: D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D004417:Dyspnea / Q000209:etiology; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology; D011175:Positive-Pressure Respiration / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D014797:Vital Capacity / Q000502:physiology
chemical_list: D002245:Carbon Dioxide