Non-invasive positive pressure ventilation should be considered in patients with COPD and persistent hypercapnia at least 2 weeks after resolution of acute respiratory failure

Commendary on: Murphy PB, Rehal S, Arbane G, 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;317:2177–86.

Implications for practice and research

Non-invasive positive pressure ventilation (NPPV) should be considered in patients with chronic obstructive pulmonary disease (COPD) with persistent hypercapnia 2–4 weeks after resolution of acute respiratory failure.

Timely follow-up after hospitalisation for acute respiratory failure is important.

Further trials are needed to confirm the findings and to clarify which patients benefit most, the role of concurrent obstructive sleep apnoeas and optimal ventilator settings of NPPV in stable hypercapnic COPD.

Context

NPPV improves outcomes and should be standard care in patients with acute hypercapnic respiratory failure, indicated by respiratory acidosis, in COPD.1

Chronic hypercapnia is common in patients with severe but stable COPD, and the benefit of NPPV in these...

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