Long‐term home non‐invasive ventilation in chronic hypercapnic chronic obstructive pulmonary disease patients: Real‐world impact on lung function, acute exacerbations and survival
Cláudia Freitas, Mariana Serino, David Araújo, Tiago Pinto, Mafalda van Zeller, Miguel Gonçalves, Marta Drummond
Abstract
Abstract Introduction Although long‐term home non‐invasive ventilation (H‐NIV) has been used among chronic hypercapnic COPD patients, its clinical benefit is still on debate. We aim to assess the impact of H‐NIV in chronic hypercapnic COPD patients. Methods COPD patients who initiated H‐NIV between January 2010 and December 2017 were included. Patients with concomitant respiratory disorders were excluded. Acute exacerbation (AE) before and 2 years after H‐NIV initiation was assessed as main outcome. Secondary outcomes included lung function and gas exchange parameters. Survival since H‐NIV initiation was determined, and factors related with survival were explored. Results Seventy‐two patients were enrolled. A decrease in partial pressure of carbon dioxide (PaCO 2 ) in arterial blood ( p < 0.001) and an improvement of partial pressure of oxygen (PaO 2 ) ( p < 0.001) were achieved using a high‐intensity H‐NIV. Regarding lung function, residual volume (RV) reduced ( p = 0.010) and forced‐expiratory volume in 1 s (FEV 1 ) improved ( p = 0.043) after H‐NIV initiation. No significant differences in 6‐min walking test (6MWT) were found. Compared with the year before H‐NIV initiation, the number of AE diminished in the first and in the second years of follow‐up ( p < 0.001). The median survival was 79.0 months (95% confidence interval [CI], 52.9–105.1), and the covered distance in 6MWT predicted survival (hazard ratio [HR] = 0.026, p = 0.003) in the multivariate analysis. Conclusions High‐intensity H‐NIV significantly improved FEV1 and hyperinflation, decreased frequency of AEs and led to a remarkable median survival, which was independently predicted by the walking distance in 6MWT.