Elsevier

Respiratory Medicine

Volume 121, December 2016, Pages 74-80
Respiratory Medicine

Efficacy of non-invasive ventilation as a rescue therapy for relieving dyspnea in patients with stable severe COPD

https://doi.org/10.1016/j.rmed.2016.11.006Get rights and content
Under an Elsevier user license
open archive

Highlights

  • NIV as rescue therapy could relieve dyspnea after exercise in stable severe COPD patients.

  • It might be an expansion of NIV use in patients with stable severe COPD.

  • NIV was effective in patients with a poor lung function to relieve exertional dyspnea.

Abstract

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

This was a randomized crossover study in 18 patients with stable severe COPD. Exertional dyspnea was induced with maximal symptom-limited incremental cycle exercise. Then the patients would randomly receive oxygen or NIV plus oxygen therapy. Patients were crossed to another therapy in the second day. During the whole process, breathing pattern were monitored continuously until complete recovery. At every 30s interval, inspiratory capacity (IC) and Borg scale were assessed. Changes were compared between two interventions.

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. Responder subgroup had significantly poorer pulmonary function in FEV1, FEV1%, IC than non-responder subgroup, indicating that NIV is effective as rescue therapy for exertional dyspnea in stable COPD with poorer pulmonary function.

NIV as rescue therapy could help relieve dyspnea after exercise in patients with stable severe COPD with a poor pulmonary function.

Keywords

Chronic obstructive pulmonary disease
Exertional dyspnea
Non-invasive ventilation
Rescue therapy

Abbreviations

FEV1
forced expiratory volume in 1s
FRC
functional residual capacity
FVC
forced vital capacity
IC
inspiratory capacity
RV
residual volume
TLC
total lung capacity
MVV
maximal voluntary ventilation
MIP
maximal inspiratory pressure
HR
heart rate
RR
respiratory rate
Vt
tidal volume
VE
minute ventilation
Ti
inspiratory time
Te
expiratory time
Ttot
total time of the respiratory cycle
Ti/Ttot
inspiratory duty cycle
Vt/Ti
mean inspiratory tidal flow
Vt/Te
mean expiratory tidal flow

Cited by (0)

Some of the results have been presented as oral presentation in the 2016 Chest World Congress conference.

1

These authors contributed equally to this work and should be considered co-first authors.