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  1. Simon Rolin
  1. Correspondence to Dr Simon Rolin, Acute and Respiratory Medicine, Heart and Lung Unit, South Devon Healthcare NHS Foundation Trust, Torbay Hospital, Newton Road, Torquay, Devon TQ2 7AA, UK; drsrolin{at}aol.com

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Domicillary NIV in severe stable COPD

A great deal of evidence exists supporting the use of in-hospital non-invasive ventilation (NIV) for acute exacerbations of COPD resulting in hypercapnic respiratory failure. However, the evidence is weak for the ability of long term NIV to improve outcomes in patients with stable hypercapnic COPD. This prospective, multicentre, randomised, controlled trial (Lancet Respir Med 2014. doi:10.1016/S2213-2600(14)70153-5) enrolled patients with stable severe COPD and a PaCO2 of 7 kPa or higher and pH higher than 7.35. NIV was targeted to reduce baseline PaCO2 by at least 20%, or to achieve PaCO2 value of <6.5 kPa. Results showed a substantial improvement in the primary outcome. One-year mortality in the NIV group was 12% versus 33% in the control group; HR 0.24 (95% CI 0.11 to 0.49; p=0.0004). For patients with advanced, stable, hypercapnic COPD, the addition of long-term NIV targeted to markedly reduce hypercapnia to standard treatment, improves survival.

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