Long-Term Non-Invasive Ventilation (NIV) for COPD Patients with Chronic Respiratory Failure

Chronic obstructive pulmonary disease (COPD) is a major health issue worldwide, with disease burden, healthcare costs, and mortality rates all significant and increasing. Non-invasive ventilation (NIV) is used to manage acute exacerbations of COPD associated with mild-to-moderate acidosis. Continuing NIV after discharge can reduce the risk of re-exacerbation, and decrease hospitalisation rates and healthcare resource use. A number of positive effects have been documented during NIV treatment in patients with stable hypercapnic COPD. These include reductions in hypercapnia and hypoxaemia, improvements in quality of life (QoL) and neuropsychological function, reduced hospital admissions and costs, and improved benefit from pulmonary rehabilitation. The effect of NIV targeting carbon dioxide reduction on long-term survival remains to be clearly determined, but is the subject of ongoing research. Overall, accumulating evidence suggests that NIV also has a role in the long-term management of stable hypercapnic COPD. It is expected that long-term NIV will be most useful for the subgroup of patients with frequent exacerbations of disease. Co-morbidities such as obesity, heart failure, or sleep-disordered breathing could further support the use of long-term NIV in the setting of stable hypercapnic COPD.