Why treat COPD patients with home NIV?
Recent evidence indicates that treatment with home NIV has benefits for COPD patients with persistent hypercapnia.1-4
Home NIV can improve survival and quality of life for chronic stable hypercapnia.1
Reduced risk of hospital readmission
Patients with persistent hypercapnia treated with home NIV and oxygen therapy have a lower risk of hospital readmission and death than those treated with oxygen alone.2
The results of the HOT-HMV trial and an associated health economic analysis show that home oxygen therapy plus home NIV is both clinically efficacious and cost-effective.2-4
When should patients be prescribed home NIV?
The results of recent clinical trials highlight the importance of carefully evaluating patient phenotype and the timing and delivery of home NIV to ensure that the patients treated are those most likely to benefit from therapy.5
Results from recent evidence
Published data suggest that patients with COPD and chronic hypercapnic respiratory failure or persistent hypercapnia at 2-4 weeks after an acute exacerbation are likely to benefit from home NIV.1,2
Flow diagram showing patient selection for home NIV based on clinical trial data1,2
What does home NIV look like in practice?
Choosing ventilator settings:
a clinical review
Currently available evidence suggests that use of higher inspiratory pressures that reduce elevated carbon dioxide levels are important for the success of home NIV therapy in patients with persistent hypercapnia.1,2
- 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.
- Murphy P, et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation. A Randomized Clinical Trial. JAMA 2017;317:2177-2186.
- 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). Am J Respir Crit Care Med 2018;197:A2517.
- Murphy PB, et al. Cost-Effectiveness of Home Oxygen Therapy-Home Mechanical Ventilation (HOT-HMV) for Treatment of Chronic Obstructive Pulmonary Disease (COPD) with Chronic Hypercapnic Respiratory Failure Following an Acute Exacerbation of COPD in the United States (US) Am J Respir Crit Care Med 2018;197:A2517.
- Murphy PB, Hart N. Home Non-Invasive Ventilation for COPD: How, Who and When? Arch Bronconeumol 2018;54:149-54.