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Clinical research in home NIV

Discover key findings from recent clinical research and their implications for treatment decision-making and patient selection.

Phenotyping and timing to initiation
Selection and treatment
Telemonitoring

The MONTANA research programme

Advancing real-world evidence in home NIV

The MONTANA research programme brings together a growing body of real-world evidence designed to improve the understanding and management of patients receiving home non-invasive ventilation (NIV). Using data from the French National Health Data System (SNDS), one of the world’s largest healthcare databases, covering almost 68 million individuals, the programme has analysed more than 66,000 patients receiving home NIV, including 54,545 patients with COPD, 8,842 with obesity hypoventilation syndrome (OHS) and 3,443 with amyotrophic lateral sclerosis (ALS).

By analysing patient pathways, treatment decisions and long-term outcomes in routine clinical practice, MONTANA provides valuable insights into when patients are identified, how and when home NIV is initiated, and the impact of treatment strategies on survival, hospitalisations and long-term management. Together, these findings complement evidence from clinical trials and help inform clinical decision-making across different respiratory conditions.

Read the programme summary
Download the COPD fact sheet
Download the OHS fact sheet

The HOT-HMV study

Evidence based benefits of home NIV for COPD

The HOT-HMV study3 has shown a 51% reduction in risk of hospital readmission or death in hypercapnic COPD patients treated with home non-invasive ventilation and oxygen therapy.

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Key findings of HOT-HMV

A 51% reduction in the risk of hospital readmission or death

Need to treat 6 patients to avoid one hospital readmission or death in 12 months

74% reduction in the risk of hospital readmission in the first 28 days

The exacerbation rate was reduced by 34%

High pressure ventilation effectively reduced CO2 levels and therapy was well tolerated*

Cost effectiveness of HOT-HMV therapy

Following the outcome of the HOT-HMV study3, a health economics analysis was performed to assess the cost effectiveness of HOT-HMV when compared to HOT alone among COPD patients in the UK with persistent hypercapnia after a life-threatening exacerbation.4

The analysis indicates that the probability of HOT-HMV being cost effective is 62%, based on £30,000 willingness to pay.

Who and when: selecting patients for home NIV

01

Patients recovering from acute respiratory failure associated with an exacerbation of COPD should be evaluated at 2–4 weeks after resolution of respiratory acidosis, and those with persistent hypercapnia should be given home NIV.3

02

Stable COPD patients with chronic hypercapnic respiratory failure also benefit from home NIV.5

03

Differences in the timing of home NIV initiation might explain different outcomes between studies.3,6

Read the full clinical review

Flow diagram showing patient selection for home NIV based on clinical trial data3,5.

GOLD Guidelines

Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines state that home NIV may improve hospitalisation-free survival in selected patients after recent hospitalisation, particularly those with pronounced daytime persistent hypercapnia (PaCO2 ≥52 mmHg’, Level of Evidence = B).7

ERS Guidelines

A multidisciplinary ERS Task Force committee have published evidence-based recommendations for the clinical application of long-term home NIV in chronic hypercapnic COPD patients:8

  • Use of long-term home NIV in stable hypercapnic COPD;
  • Use of long-term home NIV in COPD patients following a COPD exacerbation requiring acute NIV;
  • Use of NIV settings targeting a reduction in carbon dioxide;
  • Use of fixed pressure support as first choice ventilator mode.

How to treat COPD patients with home NIV: best practices

01

Improving elevated arterial carbon dioxide levels should be one of the main goals of home NIV9.

02

Clinical trial data show that higher inspiratory pressures targeted at reducing elevated carbon dioxide levels contribute to the success of home NIV therapy3,5.

03

High-intensity NIV does not appear to have a negative impact on adherence, sleep quality, or quality of life10.

Read the full clinical review

Patient monitoring

Effective patient monitoring is an essential component of home NIV, supporting therapy optimisation, early identification of clinical deterioration and timely intervention. Explore the resources below to discover the latest evidence, practical implementation examples and clinical guidance.

Keeping patients with severe COPD out of hospital

Discover how the DYNAMIC and RECEIVER studies demonstrate the impact of telemonitoring and digital self-management on reducing hospital admissions, improving patient outcomes and enabling more proactive COPD management.

Download the infographic
Case report: patient-specific alerts in a telemonitoring programme

Learn how Hospital Nova in Finland implemented patient-specific alerts to support proactive home NIV management, helping clinicians prioritise patients who need intervention while improving workflow efficiency and patient care.

Read the clinical case
ERS Clinical practice guideline on telemedicine in home mechanical ventilation

Explore the latest European Respiratory Society guideline on the use of telemedicine for home mechanical ventilation, including evidence-based recommendations, implementation considerations and future directions for clinical practice.

Read the paper

Featured webinars on home NIV

Explore expert perspectives on the latest real-world evidence, clinical research and best practices in home non-invasive ventilation.

What real-world evidence tells us about the future of home NIV for COPD patients

Discover how the MONTANA COPD study is helping to shape the future of home NIV. In this symposium, Prof. Jean-Louis Pépin presents findings from the largest cohort of COPD patients receiving home NIV, followed by an expert discussion on the implications for patient identification, treatment pathways and clinical practice across Europe.

Watch now
From research to clinical practice: using HFT, NIV and telemonitoring to manage chronic respiratory patients

From research to clinical practice: using HFT, NIV and telemonitoring to manage chronic respiratory patients

Watch now

Support for investigator initiated research

Resmed believes in the need to support ethical, independent clinical research, conducted by qualified third-party investigators.

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This content is intended for health professionals only.

References:

*As shown by 3 and 6 months results on quality of life and compliance

  1.  L Pepin, P. Lemeille, H. Denis, A.Josseran, F. Lavergne, A. Panes, S. Bailly, A. Palot, A. Prigent, Health trajectories before initiation of non-invasive ventilation for chronic obstructive pulmonary disease: a French nationwide database analysis, The Lancet Regional Health – Europe, 2023, 100717, ISSN 2666-7762, https://doi.org/10.1016/j.lanepe.2023.100717. 
  2. Pépin JL,HerquelotE, Denis H, et al. Impact of long-term non-invasive ventilation on severe exacerbations and survival in COPD: a French nationwide cohort study using multistate models. Thorax Published Online First: 19 May 2025. doi: 10.1136/thorax-2024-222392  
  3. Murphy P et al. Effect of HomeNoninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation. A Randomized Clinical Trial, JAMA. Published online May 21, 2017. doi:10.1001/jama.2017.4451.  
  1. Murphy PB et al. Cost-Effectiveness of Home Oxygen Therapy-Home Mechanical Ventilation (HOT-HMV) for the Treatment of Chronic Obstructive Pulmonary Disease (COPD) with Chronic Hypercapnic Respiratory Failure Following an Acute Exacerbation of COPD in the United Kingdom (UK). American Journal of Respiratory and Critical Care Medicine 2018;197:A2517
  2. Köhnlein T, et al., Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med 2014;2:698-705.
  3. Struik FM, et al. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study. Thorax 2014;69:826-34.
  4. Vogelmeier DF, et al. Global strategy for diagnosis, management, and prevention of COPD. Am J Respir Crit Care Med 2017;195:557-82.
  5. Ergan B, Oczkowski S, Rochwerg B, et al. European Respiratory Society Guideline on Long-term Home Non-Invasive Ventilation for Management of Chronic Obstructive Pulmonary Disease. Eur Respir J 2019; in press (https://doi.org/10.1183/13993003.01003-2019).
  6. Nocturnal non-invasive positive pressure ventilation for COPD. Windisch W et al. Expert Rev Respir Med. 2015 Jun; 9(3):295-308
  7. Dreher M, et al. Noninvasive ventilation in COPD: impact of inspiratory pressure levels on sleep quality. Chest 2011;140:939-45

Content update: 08/2026 

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