Introduction and objectives Patients with severe COPD experience breathlessness leading to exercise limitation impacting on QoL. Pulmonary rehabilitation (PR) can improve QoL, but those with the severest disease are frequently hospitalised and cannot readily access PR. Previous studies have trialled positive pressure as a means of relieving ventilatory load, allowing more severe COPD patients to exercise.1 Studies have assessed mixed pathology or stable COPD patients.2,3 In this study, we have assessed patients with severe COPD admitted to hospital with Type 2 respiratory failure and acidosis treated with acute NIV.
Methods 18 patients (11 female), recruited during admission were randomised into 3 groups. Group 1 received standard hospital physiotherapy care; Group 2 exercised on NIV (Trilogy 100, Philips-Respironics) with a mean pressure support of 10 cmH2O twice weekly during admission; Group 3 exercised on NIV twice weekly during hospital admission and continued this at home for 3 months post-discharge. Exercising included weights, pedal cycling and walking. QoL was assessed using the St Georges Respiratory Questionnaire (SGRQ) and the London Chest Activities of Daily Living Questionnaire (LCADL). Mean changes in total scores for SGRQ and LCADL were compared between baseline and at 3 months (M3). Data are mean±SD or mean (range).
Results The group (n = 18) age was 66.5 years [46–97], FEV1: 25% predicted [9–51%] and MRC score 3 [1–4]). 3/18 patients died during the study. The results are presented in Table 1.
Conclusion Patients exercising with NIV, in hospital and at home twice weekly (Group 3) showed the greatest improvement in QoL, compared to the other two groups. The use of NIV during exercise at home may assist patients unable to access pulmonary rehabilitation.
Maltais F et al. Am J Respir Crit Care Med 1995;151:1027–33
Menadue C et al. Respiratory Medicine 2010;104:219–227
Dyer F et al. BMC Pulmonary Medicine 2011;11:581–26