Obstructive Lung Diseases: COPD |

The Efficacy of Non-Invasive Mechanical Ventilation as a Rescue Therapy for Relieving Dyspnea in Patients With Stable Severe COPD FREE TO VIEW

Yonger Ou, PhD; Zhimin Lin; Weiliang Wu; Qun Luo; Rongchang Chen
Author and Funding Information

National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A347. doi:10.1016/j.chest.2016.02.362
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 09:45 AM - 11:15 AM

PURPOSE: The purpose of this study was to evaluate the effectiveness of NIV as rescue therapy in relieving exertional dyspnea in stable severe COPD patients.

METHODS: This was a randomized crossover study in 18 male patients with stable severe-to-very severe COPD (mean ± SD FEV1: 29.5 ± 6.9% predicted). Exertional dyspnea was induced with maximal symptom-limited incremental cycle exercise. Then the patients would randomly receive oxygen therapy or NIV plus oxygen therapy. Patients were crossed to another therapy group in the second day. During the whole process, HR, SpO2 and breathing pattern were monitored continuously until complete recovery. At every 30s interval, inspiratory capacity (IC) and severity of dyspnea (Borg scale) were assessed. Changes in IC, ventilation, breathing pattern, dyspnea intensity and total dyspnea recovery time were compared between two interventions.

RESULTS: Compared with oxygen therapy, NIV plus oxygen therapy resulted in increase of tidal volume and minute ventilation, decrease in dyspnea intensity at isotime (reduction of 1.0±2.0 Borg units, p < 0.05) and a tendency but not statistically significant shortening in total dyspnea recovery time (326.2±132.0s vs 356.5±156.9s, p=0.225). These improvements were negatively correlated with baseline FEV1 (r = −0.617, p < 0.01). Subjects were divided into responders (n=9) with dyspnea recovery time shortening > 30s or non-responders (n=9). Responder subgroup had poorer pulmonary function in FEV1 (p < 0.01), FEV1% (p < 0.01), inspiratory capacity (p < 0.05) than non-responder subgroup, indicating that NIV is effective as rescue therapy for exertional dyspnea in stable COPD with poorer pulmonary function.

CONCLUSIONS: NIV plus oxygen as a rescue therapy could help relieve dyspnea in patients with stable severe COPD with a poor pulmonary function.

CLINICAL IMPLICATIONS: Exertional Dyspnea is a troublesome symptom in severe chronic obstructive pulmonary disease (COPD) even after optimal medication therapy, which is a physiological and perceptional burden to limit their activities. Non-invasive mechanical ventilation (NIV) might provide rescue therapy for this population to relieve exertional dyspnea.

DISCLOSURE: The following authors have nothing to disclose: Yonger Ou, Zhimin Lin, Weiliang Wu, Qun Luo, Rongchang Chen

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