European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

Abstract

Background: While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.

Materials and methods: The European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.

Results: The task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.

Conclusions: Managing hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

Conflict of interest statement

Conflict of interest: B. Ergan reports personal fees for advisory board work from Breas, outside the submitted work. Conflict of interest: S. Oczkowski has nothing to disclose. Conflict of interest: B. Rochwerg has nothing to disclose. Conflict of interest: A. Carlucci reports personal fees for consultancy from Resmed and Breas, personal fees for lectures from Philips, outside the submitted work. Conflict of interest: M. Chatwin has received lecturing fees on the subject of cough augmentation from Breas Medical, MPR and Phillips, is a member of Breas clinical advisory board, and has attended a tele-monitoring development meeting with Resmed. Conflict of interest: E. Clini has nothing to disclose. Conflict of interest: M. Elliott reports personal fees from Philips-Respironics, ResMed, and Fisher and Paykel, outside the submitted work. Conflict of interest: J. Gonzalez-Bermejo has nothing to disclose. Conflict of interest: N. Hart reports unrestricted grants from Fisher Paykel, Philips and Resmed within and outside the direct area of work commented on here with the funds held and managed by Guy's and St Thomas' NHS Foundation Trust; financial support from Philips for development of the MYOTRACE technology that has patent filed in Europe (US patent pending) outside the area of work commented on here; personal fees for lecturing from Philips-Respironics, Philips, Resmed, Fisher-Paykel both within and outside the area of work commented on here with funds held by Guy's and St Thomas' Charity; membership of the Pulmonary Research Advisory Board for Philips outside the area of work commented on here with the funds for this role held by Guy's and St Thomas' NHS Foundation Trust; and is Joint Editor-in-Chief for Thorax. Conflict of interest: M. Luján reports to be member of the Clinical Advisory Board from Breas and received speaking fees from ResMed and Philips, during the conduct of the study. Conflict of interest: J. Nasilowski reports personal fees for lectures from ResMed and Phillips, and employed consultancy from AirLiquide, outside the submitted work Conflict of interest: S. Nava reports personal fees for advisory board work from Breas and Philips, grants from Fisher and Paykel, outside the submitted work. Conflict of interest: J.L. Pépin reports grants from Air Liquide Foundation, Mutualia and Vitalaire, grants and personal fees from Agiradom, AstraZeneca, Philips and Resmed, personal fees from Boehringer Ingelheim, Jazz Pharmaceutical, Night Balance and SEFAM, outside the submitted work. Conflict of interest: L. Pisani reports personal fees and travel expense reimbursement from Resmed, travel expense reimbursement from Fisher and Paykel, personal fees from Chiesi and Menarini, outside the submitted work Conflict of interest: J.H. Storre reports grants and personal fees for lectures from Heinen und Löwenstein and VitalAire, grants, personal fees for lectures and non-financial support for meeting attendance from Vivisol GmbH, grants from Weinmann Deutschland, personal fees for consultancy/advisory board work from Breas Medical, during the conduct of the study; personal fees for consultancy and lectures, and non-financial support for meeting attendance from Boehringer Ingelheim Pharma, personal fees for consultancy and lectures from SenTec AG, Keller Medical GmbH, Linde Deutschland and Santis GmbH, outside the submitted work. Conflict of interest: P. Wijkstra reports grants and personal fees from Philips, Resmed, grants from Vital Air, Vivisol and Goedegebuure, personal fees from Synapse and Bresotec, outside the submitted work. Conflict of interest: T. Tonia acts as ERS methodologist. Conflict of interest: J. Boyd is an employee of the European Lung Foundation. Conflict of interest: R. Scala has nothing to disclose. Conflict of interest: W. Windisch reports grants from Weinmann/Germany, Vivisol/Germany, Heinen und Löwenstein/Germany, VitalAire/Germany and Philips/Respironics/USA, during the conduct of the study; lecture fees from companies dealing with mechanical ventilation (Weinmann/Germany, Vivisol/Germany, Heinen und Löwenstein/Germany, VitalAire/Germany and Philips/Respironics/USA), outside the submitted work.

Copyright ©ERS 2019.