Adding Non-Invasive Ventilation to COPD Therapy Improves Outcomes

The World Health Organization (WHO) estimates that Chronic Obstructive Pulmonary Disease (COPD)—currently the third leading cause of death in the United States—will be the world’s third largest killer disease by 2020.

COPD includes progressive lung diseases such as emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. This disease is characterized by increasing breathlessness.

Patients with COPD also experience recurrent flare-ups that can cause intermittent periods of severe clinical deterioration requiring hospitalization and ventilator support.

Among patients with persistent hypercapnia (excess carbon dioxide in their blood) following a COPD exacerbation, the addition of in-home noninvasive ventilation (NIV) to oxygen therapy improves outcomes, according to new research.

The results of the study, published in the Journal of the American Medical Association (JAMA), showed a reduced risk of readmissions to hospital or death following an acute infection.

The data was presented on Sunday, May 21, at the 2017 American Thoracic Society International Conference in Washington, DC.

Non-invasive ventilation

The HOT-HMV trial (Home Oxygen Therapy-Home Mechanical Ventilation), was a phase III, multicenter, open-label, parallel-group randomized clinical trial. After screening for persistent hypercapnia following a COPD flare-up, 59 patients were randomly assigned to home oxygen alone and 57 patients to home oxygen plus home NIV (the use of a mask and machine to support breathing).

Among the 116 patients, 64 completed the 12-month study, with 28 receiving home oxygen alone and 36 receiving home oxygen plus home NIV. The median time to readmission or death was 4.3 months in the home oxygen plus home NIV group versus 1.4 months in the home oxygen alone group.

The 12-month risk of readmission or death was 63 percent in the home oxygen plus home NIV group versus 80 percent in the home oxygen alone group. At 12 months, 16 patients had died in the home oxygen plus home NIV group versus19 in the home oxygen alone group.

At-home treatment

The trial results could pave the way for a complete change in the way that the most severely affected COPD patients across the world are treated, said trial investigators Nicholas Hart, Ph.D., and Patrick Murphy, Ph.D. from Lane Fox Respiratory Service based at Guy’s and St Thomas’ NHS Foundation Trust in London, in a statement.

“The only current treatment we have to give these patients is oxygen therapy, but now we can give them oxygen as well as a ventilator in their home,” said Hart. “We have managed to reduce the likelihood of readmission to hospital by almost 50 percent.”

The trial follow-up will continue, as patients are monitored for survival rates over the next three and five years.

“These results are extremely promising but the work will continue. So far we have found that patients using home oxygen with a home ventilator device are two-thirds less likely to be readmitted within 28 days,” says Professor Hart.

“In the trial we used a home ventilator that co-ordinates itself with the individual patient’s breathing” he explained. “The mask ventilator machine works by blowing in air and oxygen to keep oxygen levels high and carbon dioxide, the waste gas, low.”