The HOT-HMV study 1 has shown a 51% reduction in risk of hospital readmission or death in hypercapnic COPD patients treated with home non-invasive ventilation and oxygen therapy.
Patients recovering from acute respiratory failure associated with an exacerbation of COPD should be evaluated at 2–4 weeks after resolution of respiratory acidosis, and those with persistent hypercapnia should be given home NIV.1
Stable COPD patients with chronic hypercapnic respiratory failure also benefit from home NIV.3
Differences in the timing of home NIV initiation might explain different outcomes between studies.1,4
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Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines state that home NIV may improve hospitalisation-free survival in selected patients after recent hospitalisation, particularly those with pronounced daytime persistent hypercapnia (PaCO2 ≥52 mmHg’, Level of Evidence = B).5
A multidisciplinary ERS Task Force committee has published evidence-based recommendations that conditionally support the application of LTH-NIV to improve health outcomes by using fixed pressure settings and targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure.6
Improving elevated arterial carbon dioxide levels should be one of the main goals of home NIV.7
Clinical trial data show that higher inspiratory pressures targeted at reducing elevated carbon dioxide levels contribute to the success of home NIV therapy.1,3
High-intensity NIV does not appear to have a negative impact on adherence, sleep quality, or quality of life.1,8,9
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