Abstract

Rationale: Long-term noninvasive positive pressure ventilation (NIPPV) might improve the outcomes of pulmonary rehabilitation in severe COPD patients with chronic respiratory failure.

Objective: To investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation as compared to pulmonary rehabilitation alone improves health-related quality of life, functional status, and gas exchange in COPD patients with chronic hypercapnic respiratory failure.

Measurements: Seventy-two COPD patients were randomly assigned to nocturnal NIPPV in addition to rehabilitation (n=37) or rehabilitation alone (n=35). Before and after the 3-months intervention period outcome measures were assessed.

Results: The Chronic Respiratory Questionnaire total score improved 15.1 points with NIPPV + rehabilitation, compared to 8.7 points with only rehabilitation. The difference of 7.5 points was not significant (p=0.08). However, compared to rehabilitation alone, the difference in the fatigue domain was greater with NIPPV + rehabilitation (mean difference 3.3 points, p<0.01), as was the improvement in the Maugeri Respiratory Failure questionnaire total score (mean difference -10%, p<0.03) and its cognition domain (mean difference -22%, p<0.01). Furthermore, the addition of NIPPV improved daytime arterial carbon dioxide pressure (mean difference -0.3 kPa; p<0.01), and daily step count (mean difference 1269 steps/ day, p<0.01). This was accompanied by an increased daytime minute ventilation (mean difference 1.4 L; p<0.001).

Conclusion: Noninvasive ventilation augments the benefits of pulmonary rehabilitation in COPD patients with chronic hypercapnic respiratory failure as it improves several measures of health-related quality of life, functional status, and gas exchange.