Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD.
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.
Duiverman
M L
ML
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
Wempe
J B
JB
Bladder
G
G
Jansen
D F
DF
Kerstjens
H A M
HA
Zijlstra
J G
JG
Wijkstra
P J
PJ
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
D002245:Carbon Dioxide