DJ Meecham Jones, EA Paul, PW Jones and JA Wedzicha
Respiratory Care Unit, London Chest Hospital, United Kingdom.

Non-invasive ventilation has been used in chronic respiratory failure due to chronic obstructive pulmonary disease (COPD), but the effect of the addition of nasal positive-pressure ventilation to long-term oxygen therapy (LTOT) has not been determined. We report a randomized crossover study of the effect of the combination of nasal pressure support ventilation (NPSV) and domiciliary LTOT as compared with LTOT alone in stable hypercapnic COPD. Fourteen patients were studied, with values (mean +/- SD) of Pao2 of 45.3 +/- 5.7 mm Hg, PaCO2 of 55.8 +/- 3.6 mm Hg, and FEV1 of 0.86 +/- 0.32 L. A 4 wk run-in period (on usual therapy) was followed by consecutive 3-mo periods of: (1) oxygen therapy alone, and (2) oxygen plus NPSV in randomized order. Assessments were made during run-in and at the end of each study period. There were significant improvements in daytime arterial PaO2 and PaCO2, total sleep time, sleep efficiency, and overnight PaCO2 following 3 mo of oxygen plus NPSV as compared with run-in and oxygen alone. Quality of life with oxygen plus NPSV was significantly better than with oxygen alone. The degree of improvement in daytime PaCO2 was correlated with the improvement in mean overnight PaCO2. Nasal positive- pressure ventilation may be a useful addition to LTOT in stable hypercapnic COPD.

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				N. S. Hill Noninvasive Ventilation Has Been Shown to be Ineffective in Stable COPD Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): 689 - 690. [Full Text] [PDF]

				A. ROSSI REBUTTAL FROM DR. ROSSI Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): 691a - 691. [Full Text] [PDF]

				N. S. Hill REBUTTAL FROM DR. HILL Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): 691b - 691. [Full Text] [PDF]

				W. T. McNicholas Impact of Sleep in COPD Chest, February 1, 2000; 117(2_suppl): 48S - 53S. [Abstract] [Full Text] [PDF]

				G. J. Criner, K. Brennan, J. M. Travaline, and D. Kreimer Efficacy and Compliance With Noninvasive Positive Pressure Ventilation in Patients With Chronic Respiratory Failure Chest, September 1, 1999; 116(3): 667 - 675. [Abstract] [Full Text] [PDF]

				Clinical Indications for Noninvasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to Restrictive Lung Disease, COPD, and Nocturnal HypoventilationA Consensus Conference Report Chest, August 1, 1999; 116(2): 521 - 534. [Full Text] [PDF]

				S E Jones, S Packham, M Hebden, and A P Smith Domiciliary nocturnal intermittent positive pressure ventilation in patients with respiratory failure due to severe COPD: long term follow up and effect on survival Thorax, June 1, 1998; 53(6): 495 - 498. [Abstract] [Full Text]

				R. E. Hillberg and D. C. Johnson Noninvasive Ventilation N. Engl. J. Med., December 11, 1997; 337(24): 1746 - 1752. [Full Text] [PDF]

				T. A. R. SEEMUNGAL, G. C. DONALDSON, E. A. PAUL, J. C. BESTALL, D. J. JEFFRIES, and J. A. WEDZICHA Effect of Exacerbation on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., May 1, 1997; 157(5): 1418 - 1422. [Abstract] [Full Text]