Home Ventilation Improves Outcomes for Patients with COPD

Adding home noninvasive ventilation (NIV) to oxygen therapy for the treatment of patients with persistent hypercapnia after a chronic obstructive pulmonary disease (COPD) exacerbation improved 12-month mortality and readmission rates, according to the findings of a recent study.

The randomized clinical trial included 116 patients with persistent hypercapnia 2 to 4 weeks after the resolution of respiratory acidemia (mean age 67 years, 53% of participants were female). Fifty-nine participants were randomly assigned to home oxygen therapy alone and 57 participants were randomly assigned to home oxygen plus home NIV. Time to readmission or death within the first 12 months were the main outcomes of the study.
____________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Study Defines Subgroups Within Asthma/COPD Overlap
Non-Cardiac Comorbidities Common in Heart Failure Patients
____________________________________________________________________________________________________________________________________________________________________

Of the 116 participants, 64 completed the 12-month study period, 28 of whom were in the home oxygen alone group and 36 were in the home oxygen plus home NIV group. A total of 16 patients in the home oxygen plus NIV group and 16 participants in the oxygen group died over the course of the 12-month study period.

The median time to readmission or death for participants in the home oxygen plus NIV group was 4.3 months compared with 1.4 months for participants who only received oxygen.

In the home oxygen and NIV group, the 12-month risk of readmission or death was 63.4% compared with 80.4% in participants who only received home oxygen, with an absolute risk reduction of 17%.

“In this randomized clinical trial, an improvement in time to readmission or death was observed when home noninvasive ventilation was added to home oxygen therapy in patients with persistent hypercapnia following a life-threatening acute exacerbation of COPD,” the researchers concluded. “These data support the screening of patients with COPD after receiving acute noninvasive ventilation to identify persistent hypercapnia and introduce home noninvasive ventilation.”

—Melissa Weiss

Reference:

Murphy PB, Rehal S, Arbane G, et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial [published online May 21, 2017]. JAMA. doi:10.1001/jama.2017.4451.