Noninvasive ventilation in chronic respiratory failure: effects on quality of life.
BACKGROUND
Noninvasive ventilation (NIV) has been found to be an essential technique to treat chronic respiratory failure (CRF) resulting from restrictive thoracic disorders (RTD). The last decades were characterized by the expansion of NIV to treat patients suffering from various other conditions, such as chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS).


OBJECTIVE
The aim of this study was to evaluate the effect of NIV on health-related quality of life (HRQoL) of patients with CRF during 2 years and to identify parameters associated with changes in HRQoL.


METHODS
Ninety-one patients with CRF [35 COPD; 17 RTD; 28 OHS; 11 neuromuscular diseases (NMD)] participated. HRQoL was assessed with the SF-36 questionnaire. Additional measurements included blood gases, pulmonary function tests, dyspnea, daytime sleepiness, exacerbations and hospitalizations. The patients were evaluated every 3-6 months.


RESULTS
Improvements in SF-36 physical component summary (PCS, p < 0.0001) and mental component summary (MCS, p < 0.0001) scores in RTD and MCS in OHS (p = 0.01) and COPD (p = 0.003) were observed by the third month. PCS in OHS and COPD patients improved by the sixth month (p = 0.003 and p < 0.0001, respectively). NMD patients did not present improvements in HRQoL. Improvements in HRQoL were associated with improvements in PaO(2) and dyspnea in COPD patients, and with total hours of daily ventilator use, improvement in dyspnea, pressure support and expiratory positive airway pressure in RTD patients.


CONCLUSIONS
Home NIV is consistently effective in improving HRQoL and physiological parameters in patients with CRF. Randomized trials to identify subgroups of COPD responders are justified by our results.
Tsolaki
Vassiliki
V
Respiratory Medicine Department, University of Thessaly Medical School, Larissa, Greece. vasotsolaki @ yahoo.com
Pastaka
Chaido
C
Kostikas
Konstantinos
K
Karetsi
Eleni
E
Dimoulis
Andreas
A
Zikiri
Andriani
A
Koutsokera
Aggela
A
Gourgoulianis
Konstantinos I
KI
D000368:Aged; D018450:Disease Progression; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000628:therapy; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013147:Spirometry
D010100:Oxygen