Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD.

TLDR

Non‑invasive ventilation is used for chronic respiratory failure in COPD, but the benefit of adding nasal positive‑pressure ventilation to long‑term oxygen therapy remains unclear. This randomized crossover study examined whether combining nasal pressure support ventilation with domiciliary long‑term oxygen improves outcomes in stable hypercapnic COPD. Fourteen patients underwent a 4‑week run‑in on usual therapy followed by two 3‑month periods of oxygen alone and oxygen plus NPSV in random order, with assessments at the end of each period. After 3 months of oxygen plus NPSV, patients showed significant improvements in daytime PaO₂ and PaCO₂, total sleep time, sleep efficiency, overnight PaCO₂, and quality of life compared with oxygen alone, and daytime PaCO₂ reduction correlated with overnight PaCO₂ improvement, suggesting NPSV may be a useful addition to LTOT.

Abstract

Non-invasive ventilation has been used in chronic respiratory failure due to chronic obstructive pulmonary disease (COPD), but the effect of the addition of nasal positive-pressure ventilation to long-term oxygen therapy (LTOT) has not been determined. We report a randomized crossover study of the effect of the combination of nasal pressure support ventilation (NPSV) and domiciliary LTOT as compared with LTOT alone in stable hypercapnic COPD. Fourteen patients were studied, with values (mean +/- SD) of Pao2 of 45.3 +/- 5.7 mm Hg, PaCO2 of 55.8 +/- 3.6 mm Hg, and FEV1 of 0.86 +/- 0.32 L. A 4 wk run-in period (on usual therapy) was followed by consecutive 3-mo periods of: (1) oxygen therapy alone, and (2) oxygen plus NPSV in randomized order. Assessments were made during run-in and at the end of each study period. There were significant improvements in daytime arterial PaO2 and PaCO2, total sleep time, sleep efficiency, and overnight PaCO2 following 3 mo of oxygen plus NPSV as compared with run-in and oxygen alone. Quality of life with oxygen plus NPSV was significantly better than with oxygen alone. The degree of improvement in daytime PaCO2 was correlated with the improvement in mean overnight PaCO2. Nasal positive-pressure ventilation may be a useful addition to LTOT in stable hypercapnic COPD.