title: Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients.
abstract: OBJECTIVE
  Long-term non-invasive ventilation (NIV) has become a widespread modality of treatment in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. However, benefits in terms of patient-related outcomes are still under debate. Both NIV adherence and heterogeneous responses in different COPD phenotypes may contribute to the difficulty of demonstrating NIV benefits. Our aim was to assess the impact of NIV adherence on the rate of hospitalization for acute exacerbation and death.
  
  
  METHODS
  This is a prospective multi-centre cohort study of COPD patients treated by long-term NIV. Comorbidities, anthropometrics, respiratory parameters were collected at inclusion in the study. Follow-up data included vital status, NIV adherence and hospitalizations. The influence of NIV adherence on prognosis was tested using an adjusted Cox model. Sensitivity analyses for obese and non-obese COPD subtypes were also conducted.
  
  
  RESULTS
  Two hundred thirteen patients (48% obese) were included with 45.5% died during 47.7 [interquartile range = 27.8; 73] months' follow-up. Survival was better in obese COPD than non-obese COPD. The use of NIV > 9 h/day was associated with an increased risk of death or hospitalization for acute exacerbation [HR = 1.6; 95CI: 1.1-2.4]. In obese COPD, this risk described a U-shaped curve from >1 to >9 h/day NIV usage with an improvement in prognosis when NIV adherence was > 5 h/day [HR = 0.5; 95CI: 0.2-0.9].
  
  
  CONCLUSIONS
  Adherence to NIV was associated with better prognosis only in obese COPD. NIV use > 9 h/day predicted poor outcomes.
authors.affiliation: INSERM Unit 1042, Grenoble Alpes University, Grenoble, France; Physiology and Sleep Unit, Michallon University Hospital, Grenoble, France.
authors.forename: Jean-Christian
authors.initials: JC
authors.lastname: Borel
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pepin
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: Jesus
authors.initials: J
authors.lastname: Gonzalez-Bermejo
authors.forename: Isabelle
authors.initials: I
authors.lastname: Court-Fortune
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology*; D010349:Patient Compliance; D010641:Phenotype; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: chronic obstructive pulmonary disease; exacerbation; hypoventilation; non-invasive ventilation; obesity