title: Long-term home noninvasive mechanical ventilation increases systemic inflammatory response in chronic obstructive pulmonary disease: a prospective observational study.
abstract: BACKGROUND
  Long-term home noninvasive mechanical ventilation (NIV) is beneficial in COPD but its impact on inflammation is unknown. We assessed the hypothesis that NIV modulates systemic and pulmonary inflammatory biomarkers in stable COPD.
  
  
  METHODS
  Among 610 patients referred for NIV, we shortlisted those undergoing NIV versus oxygen therapy alone, excluding subjects with comorbidities or non-COPD conditions. Sputum and blood samples were collected after 3 months of clinical stability and analyzed for levels of human neutrophil peptides (HNP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-alpha). Patients underwent a two-year follow-up. Unadjusted, propensity-matched, and pH-stratified analyses were performed.
  
  
  RESULTS
  Ninety-three patients were included (48 NIV, 45 oxygen), with analogous baseline features. Sputum analysis showed similar HNP, IL-6, IL-10, and TNF-alpha levels (P > 0.5). Conversely, NIV group exhibited higher HNP and IL-6 systemic levels (P < 0.001) and lower IL-10 concentrations (P < 0.001). Subjects undergoing NIV had a significant reduction of rehospitalizations during follow-up compared to oxygen group (P = 0.005). These findings were confirmed after propensity matching and pH stratification.
  
  
  CONCLUSIONS
  These findings challenge prior paradigms based on the assumption that pulmonary inflammation is per se detrimental. NIV beneficial impact on lung mechanics may overcome the potential unfavorable effects of an increased inflammatory state.
authors: Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy ; Department of Respiratory Diseases, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy.
authors: Gregorino
authors: G
authors: Paone
authors: Department of Respiratory Diseases, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy.
authors: Vittoria
authors: V
authors: Conti
authors: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy.
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy.
authors: Elena
authors: E
authors: De Falco
authors: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy.
authors: Isotta
authors: 0000-0002-0865-8814
authors: I
authors: Chimenti
authors: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy.
authors: Mariangela
authors: 0000-0002-9036-8495
authors: M
authors: Peruzzi
authors: Department of Respiratory Diseases, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy.
authors: Corrado
authors: C
authors: Mollica
authors: Department of Respiratory Diseases, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy.
authors: Gianluca
authors: G
authors: Monaco
authors: Department of Respiratory Diseases, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy.
authors: Gilda
authors: G
authors: Giannunzio
authors: Department of Respiratory Diseases, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy.
authors: Giuseppe
authors: G
authors: Brunetti
authors: IRCCS Fondazione Don Carlo Gnocchi-Onlus, Via Maresciallo Caviglia 30, 00194 Rome, Italy.
authors: Giovanni
authors: G
authors: Schmid
authors: Department of Anesthesia and Intensive Care Medicine, S. Giovanni Battista Molinette Hospital, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.
authors: V Marco
authors: VM
authors: Ranieri
authors: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy ; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Via Atinense 18, Pozzilli, 86077 Isernia, Italy.
authors: Giacomo
authors: 0000-0003-2703-3761
authors: G
authors: Frati
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007249:Inflammation / Q000276:immunology*; D016753:Interleukin-10 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000276:immunology*; D012121:Respiration, Artificial / Q000009:adverse effects*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10