Impact of non-invasive ventilation on exacerbation frequency in COPD patients

Abstract

AbstractBACKGROUNDAcute exacerbations of COPD are key events in the natural course of the patients illness, as they significantly impair the health condition, accelerate the deterioration of lung function, worsen the prognosis for the patient and account for the majority of the COPD-related healthcare costs. Particularly in patients with a pre-existing non-invasive ventilation (NIV) therapy, a reduction of exacerbation frequency is crucial, as they are at high risk for a lasting morbidity and increased mortality.METHODOLOGYA prospective cohort study was conducted. Data from adult patients with the diagnosis COPD and existing High-Intensity NIV (HINIV) therapy from August 2021 to September 2023 was analyzed. Exacerbation history of moderate and severe exacerbations of the past 12 months and blood gases at initiation and during HINIV therapy were analyzed.RESULTS20 patients were included (mean age 69.2±9 years; 70% female). After initiation of HINIV therapy the frequency of exacerbation displayed a significant reduction from 1.5±0.9 to 0.5±0.5 per year (p<0.001). In addition, improvements in pCO2(73.0±22.0 mmHg vs. 44.0±4.8 mmHg; p<0.001), the pH (7.33±0.1 vs. 7.42±0.0; p<0.001) and HCO3-(33.0±4.9 mmol/l vs. 27.9±3.2 mmol/l; p<0.001) were successfully demonstrated.DISCUSSIONThe present study demonstrates the positive effects of high-intensity NIV on exacerbation rate, measured by the number of moderate and severe exacerbations in one year. Most significant effects were observed when patients had a high number of exacerbations before the initiation of NIV therapy.What are the main findings?A significant reduction in the number of exacerbations was demonstrated with HINIV.There was a strong reduction in the frequency of exacerbations, especially in patients with a high frequency of exacerbations before the HINIV therapy was initiated.What are the implications of the main findings?The exacerbation history should be a more important factor in determining the indication for NIV therapy.Further studies on the pathophysiological causes must follow in order to comprehensively assess the therapeutic effects of NIV.