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Controversies and challenges in respiratory medicine
Case for continuing community NIV and CPAP during the COVID-19 epidemic
  1. Jillian G Baker1,2,
  2. Milind Sovani2
  1. 1 School of Life Sciences, University of Nottingham, Nottingham, UK
  2. 2 Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to Professor Jillian G Baker, School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK; Jillian.Baker{at}nottingham.ac.uk

https://doi.org/10.1136/thoraxjnl-2020-214913

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    Dear Editor,

    Recent clinical guidelines regarding the use of home non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) during the COVID-19 epidemic have tried to balance the risks of stopping NIV or CPAP against the unknown potential risk of increased aerosol-related transmission to family and carers.1 2 We read with interest views put forward by Barker et al 3 but feel that wider aspects need consideration, and for NIV and CPAP separately.

    NIV use: NIV is primarily used for those with previous, or at risk from, hypercapnic respiratory failure (neuromuscular disorders, chest wall deformity, obesity or underlying lung disease, for example, COPD). Stopping home NIV risks the return of symptoms (lethargy, headache, dyspnoea and confusion), increased patient and family anxiety and precipitating life-threatening acute hypercapnia, which is likely to result in hospital admission, patient exposure to COVID-19 and other infections, as well as causing increased (and preventable) pressure …

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    Footnotes

    • Contributors JGB and MS are the sole authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JGB provides molecular pharmacology advice for CuraSen Therapeutics. MS has received speaking fees from Chiesi, StraZeneca and Radiometer, received assistance form ResMed towards attending ERS, received funding from RESMED, Breas and Philips Respironics towards organising a Sleep and Ventilation course and received a £45,000 Research Grant and four Transcutaneous carbon dioxide monitors (TCM5) as well as consumables from Radiometer towards a multicentre study.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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