Noninvasive ventilation delayed readmission, death for COPD patients on home oxygen therapy

For those with chronic obstructive pulmonary disease (COPD), complications related to recurrent exacerbations can lead to hospitalization and even death. Recent research has shown adding noninvasive ventilation to home oxygen therapy can minimize readmissions.

According to recent studies, the 28-day readmission rate for COPD was around 20 percent. Led Patrick B. Murphy, PhD, with the Lane Fox Respiratory Unit at St. Thomas’ Hospital in London, the research team examined 116 patients with COPD—59 of whom received at-home oxygen while 57 received at-home oxygen and noninvasive ventilation (NIV).

The median time to readmission or death was 4.3 months in the home oxygen therapy plus home noninvasive ventilation group compared with 1.4 months for those with oxygen therapy alone.

The 12-month risk of readmission or death was 63.4 percent in the home oxygen therapy plus home noninvasive ventilation group compared with 80.4 percent in the home oxygen therapy alone group, resulting in an absolute risk reduction of 17.0 percent.

“The results of this study support the use of in-home, high-pressure noninvasive ventilation in patients who have persistent hypercapnia for two to four weeks after resolution of respiratory acidemia requiring acute NIV,” wrote Murphy and colleagues, whose findings were published May 21 in JAMA.

Other significant findings of the study included:

• Intervention: There was no significant difference in oxygen therapy flow rates after baseline titration between the two groups.
• Mortality: Five patients in the oxygen therapy plus NIV group died during the 12-month study, while four passed away in the oxygen alone group.
• Acute COPD Exacerbation: The oxygen therapy plus home NIV group had a COPD exacerbation rate of 3.8 per year, compared to 5.1 for the oxygen alone group.

In a follow-up editorial, Nicholas Hill, MD, of Tufts Medical Center discussed the topic of NIV with home oxygen as one that required further research.

“Murphy et al suggest that home oxygen plus home NIV ‘should be considered’ for patients with persistent hypercapnia),” Hill and colleague wrote. “This is a reasonable suggestion as long as patients with reversible hypercapnia are given sufficient time to recover (two-to-four weeks after hospital discharge) and Paco₂ levels remain substantially elevated (≥52 mm Hg). After all the conflicting evidence accrued to date, more studies are needed to confirm recent findings and to better define patient characteristics and technical aspects that will optimize chances of success of home NIV for patients with COPD.”