Long-term Controlled Trial of Nocturnal Nasal Positive Pressure Ventilation in Patients With Severe COPD

Chest. 2000 Dec;118(6):1582-90. doi: 10.1378/chest.118.6.1582.

Abstract

Study objectives: To determine the 1-year efficacy of noninvasive positive pressure ventilation (NPPV) added to long-term oxygen therapy (LTOT) in patients with stable severe COPD. PATIENT SELECTION AND METHODS: We prospectively randomized 52 patients with severe COPD (FEV(1) < 45%) to either NPPV plus "standard care" (96% patients with LTOT) or to standard care alone (93% patients with LTOT). The outcomes measured included the following: rate of acute COPD exacerbations; hospital admissions; intubations; and mortality at 3 months, 6 months, and 12 months. The patients were also evaluated at 3 months and 6 months for dyspnea using the Medical Research Council and Borg scales, gas exchange, hematocrit, pulmonary function, cardiac function with echocardiogram, and neuropsychological performance.

Results: One-year survival was similar in both groups (78%). The number of acute exacerbations was similar at all time points in patients receiving NPPV, compared with control subjects. The number of hospital admissions was decreased at 3 months in the NPPV group (5% vs 15% of patients, p < 0.05), but this difference was not seen at 6 months (18% vs 19%, respectively). The only beneficial differences were observed in the Borg dyspnea rating, which dropped from 6 to 5 (p < 0.039), and in one of the neuropsychological tests (psychomotor coordination) for the NPPV group at 6 months.

Conclusions: Our study indicates that over 1 year, NPPV does not affect the natural course of the disease and is of marginal benefit in outpatients with severe COPD who are in stable condition.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Follow-Up Studies
  • Hemodynamics
  • Home Care Services
  • Hospitalization
  • Humans
  • Lung Diseases, Obstructive / mortality
  • Lung Diseases, Obstructive / physiopathology
  • Lung Diseases, Obstructive / therapy*
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Oxygen Inhalation Therapy
  • Positive-Pressure Respiration*
  • Prospective Studies
  • Respiratory Mechanics
  • Survival Rate