Portable NIV for patients with moderate to severe COPD: two randomized crossover trials
Abstract Background Long-term non-invasive ventilation (NIV) is as an established treatment option for chronic hypercapnic COPD patients. Beneficial effects have also been shown during exercise, but this is restricted to rehabilitation programs. New portable NIV (pNIV) devices may now enable NIV app...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | Respiratory Research |
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| Online Access: | https://doi.org/10.1186/s12931-021-01710-2 |
| _version_ | 1818866001125572608 |
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| author | Daniel Sebastian Majorski Friederike Sophie Magnet Saadia Thilemann Claudia Schmoor Wolfram Windisch Sarah Bettina Schwarz |
| author_facet | Daniel Sebastian Majorski Friederike Sophie Magnet Saadia Thilemann Claudia Schmoor Wolfram Windisch Sarah Bettina Schwarz |
| author_sort | Daniel Sebastian Majorski |
| collection | DOAJ |
| description | Abstract Background Long-term non-invasive ventilation (NIV) is as an established treatment option for chronic hypercapnic COPD patients. Beneficial effects have also been shown during exercise, but this is restricted to rehabilitation programs. New portable NIV (pNIV) devices may now enable NIV application during walking at home. Study design and methods In two randomized crossover trials, the impact of pNIV on dyspnea and endurance capacity was investigated in patients with moderate to severe COPD. Participants performed a standardized 6-min walking test, with and without pNIV, using a pre-set inspiratory/expiratory positive airway pressure of 18/8 cmH2O. The first study was performed in NIV-naïve patients (Study I), while the second study was performed in those already established on long-term NIV (Study II). Results 38 patients (66.9 ± 7.4 years, mean FEV1: 30.3 ± 8%pred) and 23 patients (67.6 ± 8.7 years, mean FEV1: 29.8 ± 10.4%pred) participated in Study I and II, respectively. In Study I, the mean difference in the Borg Dyspnea Scale (BDS, primary outcome) score following walking was 3.2 (IQR 2–4) without pNIV, compared to 2.6 (IQR 1–4) with pNIV (ΔBDS 0.65, P = 0.04), while walking distance increased from 311.8 m (95%CI 276.9–346.6 m) to 326.3 m (95%CI 291.5–361.2 m) (P = 0.044) when pNIV was used. Accordingly, in Study II, the mean difference in BDS was 4.4 (IQR 3–6) without pNIV, compared to 4.5 (IQR 3–6) with pNIV (ΔBDS 0.09, P = 0.54), while walking distance decreased from 291.5 m (95%CI 246.1–336.9 m) to 258.4 m (95%CI 213–303.8 m) (P ≤ 0.001). Interpretation The use of a pNIV device during walking can improve dyspnea and walking distance in patients with moderate to severe COPD. Patients who do not already receive long-term NIV therapy are more likely to benefit compared to those undergoing long-term NIV. Careful patient selection is mandatory. Clinical Trial Register: DRKS00013203; DRKS00012913 registered October 20th 2017 and October 16th 2017; https://www.drks.de/drks_web/ |
| first_indexed | 2024-12-19T10:56:30Z |
| format | Article |
| id | doaj.art-bb759c9ddd0842d59378267db9ec92fa |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-19T10:56:30Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-bb759c9ddd0842d59378267db9ec92fa2022-12-21T20:24:47ZengBMCRespiratory Research1465-993X2021-04-0122111210.1186/s12931-021-01710-2Portable NIV for patients with moderate to severe COPD: two randomized crossover trialsDaniel Sebastian Majorski0Friederike Sophie Magnet1Saadia Thilemann2Claudia Schmoor3Wolfram Windisch4Sarah Bettina Schwarz5Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of MedicineDepartment of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of MedicineDepartment of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of MedicineClinical Trials Unit, Medical Center – University of Freiburg, Faculty of Medicine, University of FreiburgDepartment of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of MedicineDepartment of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of MedicineAbstract Background Long-term non-invasive ventilation (NIV) is as an established treatment option for chronic hypercapnic COPD patients. Beneficial effects have also been shown during exercise, but this is restricted to rehabilitation programs. New portable NIV (pNIV) devices may now enable NIV application during walking at home. Study design and methods In two randomized crossover trials, the impact of pNIV on dyspnea and endurance capacity was investigated in patients with moderate to severe COPD. Participants performed a standardized 6-min walking test, with and without pNIV, using a pre-set inspiratory/expiratory positive airway pressure of 18/8 cmH2O. The first study was performed in NIV-naïve patients (Study I), while the second study was performed in those already established on long-term NIV (Study II). Results 38 patients (66.9 ± 7.4 years, mean FEV1: 30.3 ± 8%pred) and 23 patients (67.6 ± 8.7 years, mean FEV1: 29.8 ± 10.4%pred) participated in Study I and II, respectively. In Study I, the mean difference in the Borg Dyspnea Scale (BDS, primary outcome) score following walking was 3.2 (IQR 2–4) without pNIV, compared to 2.6 (IQR 1–4) with pNIV (ΔBDS 0.65, P = 0.04), while walking distance increased from 311.8 m (95%CI 276.9–346.6 m) to 326.3 m (95%CI 291.5–361.2 m) (P = 0.044) when pNIV was used. Accordingly, in Study II, the mean difference in BDS was 4.4 (IQR 3–6) without pNIV, compared to 4.5 (IQR 3–6) with pNIV (ΔBDS 0.09, P = 0.54), while walking distance decreased from 291.5 m (95%CI 246.1–336.9 m) to 258.4 m (95%CI 213–303.8 m) (P ≤ 0.001). Interpretation The use of a pNIV device during walking can improve dyspnea and walking distance in patients with moderate to severe COPD. Patients who do not already receive long-term NIV therapy are more likely to benefit compared to those undergoing long-term NIV. Careful patient selection is mandatory. Clinical Trial Register: DRKS00013203; DRKS00012913 registered October 20th 2017 and October 16th 2017; https://www.drks.de/drks_web/https://doi.org/10.1186/s12931-021-01710-2COPDRespiratory insufficiencyEndurance capacityNon-invasive ventilation |
| spellingShingle | Daniel Sebastian Majorski Friederike Sophie Magnet Saadia Thilemann Claudia Schmoor Wolfram Windisch Sarah Bettina Schwarz Portable NIV for patients with moderate to severe COPD: two randomized crossover trials Respiratory Research COPD Respiratory insufficiency Endurance capacity Non-invasive ventilation |
| title | Portable NIV for patients with moderate to severe COPD: two randomized crossover trials |
| title_full | Portable NIV for patients with moderate to severe COPD: two randomized crossover trials |
| title_fullStr | Portable NIV for patients with moderate to severe COPD: two randomized crossover trials |
| title_full_unstemmed | Portable NIV for patients with moderate to severe COPD: two randomized crossover trials |
| title_short | Portable NIV for patients with moderate to severe COPD: two randomized crossover trials |
| title_sort | portable niv for patients with moderate to severe copd two randomized crossover trials |
| topic | COPD Respiratory insufficiency Endurance capacity Non-invasive ventilation |
| url | https://doi.org/10.1186/s12931-021-01710-2 |
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