title: Randomized trial of non-invasive ventilation combined with exercise training in patients with chronic hypercapnic failure due to chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Non-invasive ventilation and exercise training might prove beneficial in the management of COPD patients.
  
  
  OBJECTIVE
  to compare the combined use of exercise training and non-invasive ventilation with the two interventions separately in chronic respiratory failure due to chronic obstructive pulmonary disease. As primary objective exercise capacity and secondary objectives gas exchange, peripheral muscle strength, BODE index, quality of life and systemic inflammatory response.
  
  
  METHODS
  Forty-five patients with severe chronic obstructive pulmonary disease were randomized into three groups for an intervention of 12 weeks: exercise training alone, ventilation alone and combined treatment. We assessed exercise capacity, pulmonary function, BODE index, perception of dyspnoea, quality of life and several biomarkers.
  
  
  RESULTS
  All exercise capacity parameters improved after training and the combined treatment. In addition, peripheral muscle strength and six-minute walk distance increased after ventilation. We found differences between the combined group and the ventilation group in submaximal effort and in oxygen consumption. Changes in respiratory function were observed in blood gases that improved after ventilation and the combined treatment, with differences between these groups. BODE index, perception of dyspnoea and quality of life improved in all three groups without differences between groups. Levels of interleukin 8 and tumour necrosis factor α decreased after ventilation, and interleukin 8, C-reactive protein and surfactant protein D decreased after training, while all four of these markers fell after the combined treatment. No differences between groups were found.
  
  
  CONCLUSIONS
  The combination of ventilation and exercise training had greater benefits than the separate treatments: improvements were observed in both blood gases and the levels of more biomarkers decreased. In addition, submaximal exercise capacity increased in all groups. The improvements seen in BODE index, perception of dyspnoea and quality of life were similar in all groups.
authors.affiliation: Medical-Surgical Unit or Respiratory Diseases, Virgen del Rocío University Hospital, Spain; Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain. Electronic address: eduardomarquezmartin@gmail.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Márquez-Martín
authors.affiliation: Medical-Surgical Unit or Respiratory Diseases, Virgen del Rocío University Hospital, Spain; Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Francisco Ortega
authors.initials: FO
authors.lastname: Ruiz
authors.affiliation: Medical-Surgical Unit or Respiratory Diseases, Virgen del Rocío University Hospital, Spain; Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain.
authors.forename: Pilar Cejudo
authors.initials: PC
authors.lastname: Ramos
authors.affiliation: Medical-Surgical Unit or Respiratory Diseases, Virgen del Rocío University Hospital, Spain; Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: López-Campos
authors.affiliation: Medical-Surgical Unit or Respiratory Diseases, Virgen del Rocío University Hospital, Spain.
authors.forename: Borja Valencia
authors.initials: BV
authors.lastname: Azcona
authors.affiliation: Medical-Surgical Unit or Respiratory Diseases, Virgen del Rocío University Hospital, Spain; Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Emilia Barrot
authors.initials: EB
authors.lastname: Cortés
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002245:Carbon Dioxide / Q000097:blood; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D063087:Noninvasive Ventilation / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D010313:Partial Pressure; D011175:Positive-Pressure Respiration / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications / Q000628:therapy*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000628:therapy*
chemical_list: D015415:Biomarkers; D002245:Carbon Dioxide; D010100:Oxygen
keywords: COPD; Exercise capacity; Exercise training; Non-invasive ventilation; Respiratory muscle training