Non-invasive ventilation

Non-invasive ventilation: new tool for the treatment of advanced COPD

Treatment of patients with advanced chronic obstructive pulmonary disease (COPD) frequently includes several non pharmacological approaches, such as pulmonary rehabilitation, lung volume reduction surgery and lung transplantation. One additional method is the so-called non-invasive ventilation (NIV), based on a mechanical device which rhythmically blows air through a mask attached over the nose and mouth into the lungs of the patients.

For many years NIV has rendered conflicting results regarding its effectiveness, and adherence to the treatment has been rather poor. This was bad news for a treatment which is costly and time consuming.

In a recent study, Orlando Diaz (Catholic University, Santiago, Chile) and his Canadian and Chilean colleagues have challenged this notion.

The authors used a schedule which is different from current practices, to apply NIV. Instead of applying unsupervised NIV overnight at home, they used it during daytime, for only 3 hours a day, in ambulatory patients, under close supervision at the hospital.

Patients not only tolerated the procedure better than in previous studies, but also achieved clinically significant improvements in breathlessness during daily activities. These effects were clearly evident after only three weeks of treatment. Another interesting finding was that the benefits obtained still persisted two weeks after suspension of NIV.

These new data suggest that NIV can be used intermittently for short periods, thus improving compliance and quality of life of patients with advanced disease that remain symptomatic despite full standard pharmacological therapy.