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Noninvasive Positive-Pressure Ventilation for Severe Worsening of Chronic Obstructive Pulmonary Disease
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What is the problem and what is known about it so far?
Chronic obstructive pulmonary disease (COPD) is a disease of the air sacs and air passages of the lungs. Usually caused by smoking, damage to the lungs gradually worsens over time. People with COPD are short of breath and sometimes cough and wheeze. Symptoms slowly worsen over time, but most patients also have intermittent bouts of acute worsening of symptoms. Lung infections, cold weather, and exertion may bring on these bouts. With severe bouts, patients need close observation, treatment in the hospital, and, sometimes, a tube in the windpipe (trachea) to help them breathe (intubation). Rather than putting a tube down the trachea, doctors may try to force oxygen into the lungs with a mask over the mouth or nose that is connected to a breathing machine (ventilator) with a tube. This technique is called noninvasive positive-pressure ventilation (NPPV). Several recent studies have tested whether NPPV actually helps patients with severe bouts of COPD and whether it prevents the need for a tube in the trachea.
Why did the researchers do this particular study?
To see whether NPPV improves outcomes in patients with acute, severe worsening of COPD.
Who was studied?
Approximately 700 adults with acute bouts of worsening COPD from 15 different studies of NPPV.
How was the study done?
Rather than doing a new study, the researchers looked at previous randomized trials that had compared treatment with and without NPPV. Participants in the trials were patients who were hospitalized for acute worsening of COPD. All received standard medical treatments for COPD. Outcomes that were measured included length of hospital stay, deaths in the hospital, and the need for a tube in the trachea. The researchers combined outcomes across the studies to see whether patients who got NPPV did better than those who received only standard therapy without NPPV.
What did the researchers find?
Adding NPPV to standard care reduced the need for tubes in the trachea by about 28%. Adding NPPV to standard care also shortened hospital stays by 4 to 5 days and reduced hospital deaths by 10%. The researchers also found that NPPV benefited only patients with severe bouts of worsening COPD, not patients with mild worsening of symptoms.
What were the limitations of the study?
Data about hospitalized patients with milder bouts of worsened COPD were scant. Only two trials included such patients.
What are the implications of the study?
Noninvasive positive-pressure ventilation should be added to standard care for adults with severe bouts of worsening COPD.
Article and Author Information
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The summary below is from the full report titled “Which Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Benefit from Noninvasive Positive-Pressure Ventilation? A Systematic Review of the Literature.” It is in the 3 June 2003 issue of Annals of Internal Medicine (volume 138, pages 861-870). The authors are S.P. Keenan, T. Sinuff, D.J. Cook, and N.S. Hill.
- Copyright ©2004 by the American College of Physicians
