title: Use of non-invasive ventilation is increasing in patients admitted with a chronic obstructive pulmonary disease exacerbation.
abstract: BACKGROUND
  A nationwide chronic obstructive pulmonary disease (COPD) quality improvement programme--DrCOPD--was initiated in Denmark in 2008. We examined subsequent national and regional trends in the use of non-invasive ventilation (NIV) and trends in mortality following NIV and invasive mechanical ventilation among patients acutely admitted with a COPD exacerbation.
  
  
  METHODS
  We did a nationwide, population-based prospective study using DrCOPD to identify all incident hospitalizations with COPD from 2008 through 2011 (n = 24,982) and to record the use of NIV during hospitalization. Date of death was retrieved from the Danish Civil Registration System.
  
  
  RESULTS
  During follow-up, the use of NIV treatment in patients with first-time COPD hospitalization increased statistically significantly in all five Danish regions. At the national level, the use of NIV increased from 5.8% to 7.0% (adjusted for age, sex and co-morbidity, relative risk (RR): 1.21, 95% confidence interval (CI): 1.05-1.38). Concurrently, a statistically significant increase from 1.3% to 1.8% (RR: 1.36; 95% CI: 1.03-1.80) in NIV given together with invasive mechanical ventilation was observed. During the four years of follow-up, mortality remained stable with some regional variation. In-hospital mortality following NIV was also stable over time, while mortality decreased slightly in patients treated with both NIV and invasive mechanical ventilation.
  
  
  CONCLUSIONS
  Use of NIV in Denmark increased after the launch of a national COPD quality programme in 2008. However, regional variation remains and no substantial improvements in mortality have been observed. Continued efforts are warranted to ensure appropriate implementation of NIV.
  
  
  BACKGROUND
  The study was supported financially by University of Copenhagen and the Danish Lung Association.
  
  
  BACKGROUND
  The study was approved by the Danish Data Protection Agency (record no. 2012-41-0438), the Danish National Indicator Project, Danish Regions and the Danish Ministry of Health.
authors.affiliation: Department of Public Health, Section of Social Medicine, University of Copenhagen, 1014 Copenhagen, Denmark.
authors.forename: Sandra Søgaard
authors.initials: SS
authors.lastname: Tøttenborg
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
authors.forename: Ejvind Frausing
authors.initials: EF
authors.lastname: Hansen
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy*; D058996:Quality Improvement