P11 Long-term home non-invasive ventilation

Raveling et al (2021) performed a meta-analysis of chronic non-invasive ventilation use in patients with COPD and hypercapnia compared to usual care.  The analysis was separated into studies where NIV was commenced in a stable phase and studies where NIV was commenced after an exacerbation.  Data was included from 13 stable COPD studies (n= 778) and 3 post exacerbation studies (n =364).  There is a high risk of bias due to lack of blinding.  Note is made of significant differences in trial design and NIV pressures delivered.  Smoking status was not reported. Most studies excluded people with obstructive sleep apnoea. For the outcomes of quality of life and mortality sub-group analyses based on NIV pressures and baseline PaCO2 were not performed.

In the stable COPD group, quality of life scores improved with NIV, after three months (SMD 0.39, 95% CI 0.15-0.62; 5 studies, 259 participants); however, the improvement in quality of life was not sustained to 12 months. There was no effect of NIV on exercise capacity.  The risk for all-cause mortality is reduced by NIV (adjusted hazard ratio 0.75, 95% CI 0.58-0.97; 3 studies, 405 participants; moderate-certainty evidence).

In the group where NIV was commenced after an exacerbation there was no improvement in quality of life or mortality however, NIV did lead to an improvement in admission-free survival (adjusted hazard ratio 95% CI 0.54-0.94; 2 studies, 317 participants) (Raveling 2021).

There was no improvement in lung function in either group.

Long term NIV can be considered in patients with severe stable COPD and hypercapnia.  Such patients should be referred to a centre with expertise in home NIV.