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As Elliott points out in his editorial accompanying the paper by McEvoy and colleagues, chronic obstructive pulmonary disease (COPD) is the commonest indication for home non-invasive ventilation (NIV) in Europe, although there is little evidence of its benefit. McEvoy and colleagues describe the largest to date randomised controlled trial of combined NIV and long-term oxygen therapy (LTOT) compared with LTOT alone in hypercapnic COPD. The use of combined NIV and LTOT showed a survival benefit, although no changes were observed in the disease specific health status measure (St George Respiratory Questionnaire). Surprisingly, there was some worsening of quality of life on the generic questionnaires. Elliott suggests that the absence of improvement in health status may be associated with the lack of change in arterial PCO2 and …

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