Noninvasive home ventilation improves outcomes in COPD with chronic respiratory failure
Chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure (CRF) fare well with noninvasive home ventilation (NIVH) treatment, which cuts the risk of death and healthcare utilization, a study has found.
The study included 517 COPD patients who received NIVH within 2 months of CRF diagnosis and 511 matched patients who never received the treatment. The mean age of the entire cohort was 70.6 years, and 44 percent were men.
In multivariable Cox regression models, NIVH treatment yielded meaningful survival gains (adjusted hazard ratio [aHR], 0.50, 95 percent confidence interval [CI], 0.36–0.65) and substantial decrease in the incidence of hospitalization (aHR, 0.72, 95 percent CI, 0.52–0.93), and emergency room (ER) use (aHR, 0.48, 95 percent CI, 0.38–0.58).
The magnitude of benefit of NIVH diminished over time for mortality and ER visits, but remained steady for hospitalizations. In the first year following CRF diagnosis, the proportion of patients who died was 28 percent in the treated group versus 46 percent in the control group. The corresponding proportions for hospitalizations and ER visits were 55 percent and 72 percent in the NIVH group versus 67 percent and 92 percent in the control group.
The relative risk reduction was 39 percent for mortality, 17 percent for hospitalizations, and 22 percent for ER visits. Numbers needed to treat were 5.5, 9, and 5 to prevent a death, hospitalization, or ER visit at 1 year postdiagnosis, respectively.
The present data suggest that NIVH holds potential in the treatment of patients with COPD-CRF.