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Obstructive Lung Diseases |

Effects of Noninvasive Open Ventilator on the Tidal Volume and Inspiratory Effort During Exercise in Severe COPD

Robert Cao, MD; Janos Porszasz, PhD; Richard Morishige, PhD; Leo van Eykern, PhD; Alex Stenzler, BS; Richard Casaburi, MD
Author and Funding Information

Los Angeles Biomedical Research Institute, Torrance, CA


Chest. 2013;144(4_MeetingAbstracts):734A. doi:10.1378/chest.1704470
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Abstract

SESSION TITLE: COPD Treatment Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: We evaluated the effects of a 1 lb. noninvasive open ventilation (NIOV) system (Breathe Technologies, Irvine, CA) featuring a nasal pillow interface on tidal volume and inspiratory muscle effort during constant work rate (CWR) cycle ergometer exercise in severe COPD patients with exercise-induced desaturation.

METHODS: We report results of studies featuring expired gas collection during Visit 3 of a 4 visit study in which subjects performed 3 CWR tests: no ventilatory support (unencumbered, UNC) and while the NIOV system delivered compressed air (NIOV+Air) or oxygen (NIOV+O2). Fourteen male COPD patients (age: average±SD 67±8 yrs, FEV1=32±12%pred, FEV1/FVC=32±7%) were evaluated. We measured expired air volume through an oral half-mask and recorded the EMG from the scalene, intercostal and diaphragmatic muscles. Gas bolus volume delivered by the NIOV with each inhalation was titrated to subject comfort (199±42ml). The constant work rate test was conducted at 80% of peak work rate (54±28 Watts). All significances are at P<0.05 from RM ANOVA SNK test.

RESULTS: Exercise endurance was substantially higher with NIOV+O2 (17.1±6.5 min) vs. NIOV+Air (6.6±5.7min) and UNC (4.3±1.3 min) conditions. During exercise, peak tidal volume (VT) increase was greater with NIOV+O2 than NIOV+Air or UNC (0.46±0.27; 0.31±026 and 0.32±0.23 L, respectively). After reaching its peak (at 6.4±5.9, 2.8±2.5 and 2.6±1.4 min, respectively) VT decreased, reaching its minimum at end exercise in all three tests. At isotime, exercise-associated increase in scalene EMG, normalized to tidal volume increase (dEMG/dVt, uV*sec/L) was significantly reduced by NIOV+Air (8.0±7.1) and further reduced by NIOV+O2 (2.8±2.4) compared to UNC exercise (11.6±7.9). Generally, dEMG/dVT increased towards end-exercise, but the values for the scalene and intercostal muscle groups remained significantly less during NIOV+ O2 (7.9±6.6, 2.3±2.0) than UNC (11.7±9.4, 4.3±4.3). Isotime Borg dyspnea score was significantly reduced by NIOV+Air (3.8±2.8) and further reduced by NIOV+O2 (2.0±1.3) compared to UNC (5.4±3.1).

CONCLUSIONS: In severe COPD patients, the noninvasive open ventilation system yields an increased peak exercise tidal volume during exercise while significantly reducing EMG activity (a surrogate for inspiratory effort) of accessory inspiratory muscles resulting in reduced shortness of breath and improved exercise endurance.

CLINICAL IMPLICATIONS: Noninvasive open ventilator system is a feasible and effective therapeutic modality in severe COPD.

DISCLOSURE: Robert Cao: Grant monies (from industry related sources): Breathe Technologies sponsored the study Janos Porszasz: Grant monies (from industry related sources): Breathe Technologies sponsored the study Richard Morishige: Employee: Was an employee of Breathe Technologies at the time of the study Leo van Eykern: Consultant fee, speaker bureau, advisory committee, etc.: Consultant in research and development of Inbiolab BV Alex Stenzler: Consultant fee, speaker bureau, advisory committee, etc.: Alex Stenzler received consulting fees from Breathe Technologies, Inc. to serve as an advisor on the trial design and the selection of measurement technologies. Richard Casaburi: Grant monies (from industry related sources): Breathe Technologies sponsored the study, Consultant fee, speaker bureau, advisory committee, etc.: Consultancy with Breathe Technologies

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