Unclear benefit to home NIPPV in COPD
Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition that is associated with significant mortality, morbidity, and health care utilization. Use of noninvasive positive-pressure ventilation (NIPPV) in acute hypercapnic respiratory failure caused by COPD exacerbations is well established. However, the benefits of in-home NIPPV for COPD with chronic hypercapnia is unclear.
Study design: Systematic review and meta-analysis.
Setting: Multicenter catchment of 21 randomized control trials (RCTs) and 12 observational studies involving more than 51,000 patients during 1995-2019.
Synopsis: Patients included were those with COPD and hypercapnia who used NIPPV for more than 1 month. Home bilevel positive airway pressure (BiPAP), compared to no device use was associated with lower risk of mortality, all-cause hospital admission, and intubation, but no significant difference in quality of life. Noninvasive home mechanical ventilation, compared with no device was significantly associated with lower risk of hospital admission, but not a significant difference in mortality. Of note, there was no statistically significant difference in any outcome for either BiPAP or home mechanical ventilation if evidence was limited to RCTs. Importantly, on rigorous measure, the evidence was low to moderate quality or insufficient, and some outcomes analysis was based on small numbers of studies.
Bottom line: While there is suggestion of benefit on some measures with the use of home NIPPV, the evidence is not robust enough to clearly guide use.
Citation: Wilson et al. Association of home noninvasive positive pressure ventilation with clinical outcomes in chronic obstructive pulmonary disease. JAMA. 2020 Feb 4;323(5):455-65.
Dr. Sneed is assistant professor of medicine, section of hospital medicine, at the University of Virginia School of Medicine, Charlottesville.
