Chronic non-invasive ventilation in COPD: where do we stand?

This thesis is about the effects of chronic non-invasive ventilation (NIV) in COPD (chronic obstructive pulmonary disease) patients with chronic hypercapnic respiratory failure. In the first part, we systematically present what has been published in the field of stable COPD. In short, there was inconsistent evidence to recommend non-invasive ventilation in routine practice.
The second part of this thesis describes the results of the RESCUE study, in which we compared the effects of 12 months of nocturnal NIV with standard therapy in COPD patients who remained hypercapnic after ventilatory support for acute respiratory failure. Two hundred and one patients were randomized in hospital, after which measurements were performed at baseline and after 3, 6 and 12 months. When comparing nocturnal NIV to standard therapy we concluded the following:
- nocturnal NIV does not prolong the time to readmission for respiratory causes or death, the primary outcome of the study.
- nocturnal NIV does improve daytime PaCO2 and nocturnal transcutaneous PaCO2.
- nocturnal NIV does not improve number of respiratory readmissions, number of exacerbations, lung function, HRQL, mood state, daily activity levels or dyspnoea.