Long-term Controlled Trial of Nocturnal Nasal Positive Pressure Ventilation in Patients With Severe COPD

To determine the 1-year efficacy ofnoninvasive positive pressure ventilation (NPPV) added to long-termoxygen therapy (LTOT) in patients with stable severe COPD. We prospectively randomized52 patients with severe COPD (FEV1 < 45%) to either NPPVplus “standard care” (96% patients with LTOT) or to standard carealone (93% patients with LTOT). The outcomes measured included thefollowing: rate of acute COPD exacerbations; hospital admissions; intubations; and mortality at 3 months, 6 months, and 12 months. Thepatients were also evaluated at 3 months and 6 months for dyspnea usingthe Medical Research Council and Borg scales, gas exchange, hematocrit, pulmonary function, cardiac function with echocardiogram, andneuropsychological performance. One-yearsurvival was similar in both groups (78%). The number of acuteexacerbations was similar at all time points in patients receiving, NPPV, compared with control subjects. The number of hospital admissionswas decreased at 3 months in the NPPV group (5% vs 15% of patients, p < 0.05), but this difference was not seen at 6 months (18% vs19%, respectively). The only beneficial differences were observed inthe Borg dyspnea rating, which dropped from 6 to 5 (p < 0.039), andin one of the neuropsychological tests (psychomotor coordination) forthe NPPV group at 6 months. Our studyindicates that over 1 year, NPPV does not affect the natural course ofthe disease and is of marginal benefit in outpatients with severe COPDwho are in stable condition.