Trial of Non-invasive Ventilation for Stable COPD
Trial of Non-invasive Ventilation for Stable COPD
The use of domiciliary non-invasive positive pressure ventilation (NPPV) in stable chronic
 obstructive pulmonary disease (COPD) with chronic hypercapnic respiratory failure has yielded
 variable effects on survival, quality of life and dyspnea. The investigators hypothesized
 that use of NPPV in stable COPD might result in improvement in quality of life and dyspnea.
Chronic obstructive pulmonary disease (COPD) is associated with progressive decline in lung
 function with resultant chronic respiratory failure. This leads to significant rates of
 hospitalization, disability, and death. COPD is also associated with sleep disordered
 breathing and nocturnal hypoventilation, resulting in nocturnal and daytime hypoxemia and
 hypercapnia. These, in turn, can contribute to fatigue, dyspnea and impaired quality of life.
 Presence of hypercapnia is associated with a 33% 5-year survival. Nocturnal NPPV can
 theoretically rest overloaded respiratory muscles, prevent nocturnal hypoventilation, and
 reset central respiratory drive in patients with hypercapnia. The use of non-invasive
 positive pressure ventilation (NPPV) in late stage COPD appears logical to change this
 inexorable course, to alleviate symptoms and to improve quality of life. While NPPV has a
 definite role in the management of acute hypercapnic respiratory failure, its role in the
 management of late stage stable COPD is controversial. Multiple studies have shown no
 survival benefit for nocturnal NPPV in chronic hypercapnic stable COPD patients. The effects
 on quality of life and dyspnea scores in such patients have been inconsistent. The variable
 efficacy might have been due to late administration of the intervention in the course of
 disease, in the presence of advanced hypercapnic respiratory failure. We sought to assess the
 effect of applying NPPV on indices of health-related quality of life in patients with
 relative normocapnia. We hypothesized that patients with stable severe COPD have improved
 quality of life and reduced dyspnea with the use of NPPV.
Inclusion Criteria:

 -  stable chronic obstructive pulmonary disease (COPD) defined as forced expiratory
 volume in the first second (FEV1)/forced vital capacity (FVC) ratio of <0.70, with at
 least 10 pack-years smoking history

 Exclusion Criteria:

 -  congestive heart failure, obstructive sleep apnea, chronic respiratory conditions
 other than COPD, age < 35 years, any disease limiting life expectancy to less than two
 years, active malignancy other than non-melanotic skin cancer in the previous two
 years, and with any anatomic variation or disease process that precluded wearing a
 nasal mask