Long‐term adherence with non‐invasive ventilation improves prognosis in obese COPD patients. Issue 6 (9th June 2014)

• Record Type: Journal Article
• Authors: Borel, Jean‐Christian; Pepin, Jean‐Louis; Pison, Christophe; Vesin, Aurélien; Gonzalez‐Bermejo, Jesus; Court‐Fortune, Isabelle; Timsit, Jean‐François
• Is Part Of: Respirology. Volume 19:Issue 6(2014)
• Page Start: 857
• Page End: 865
• Publication Date: 2014-06-09
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.12327
• Languages: English
• ISSNs: 1323-7799

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="resp12327-sec-0001" sec-type="section"> <title>Background and objective</title> <p>Long‐term non‐invasive ventilation (NIV) has become a widespread modality of treatment in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. However, benefits in terms of patient‐related outcomes are still under debate. Both NIV adherence and heterogeneous responses in different COPD phenotypes may contribute to the difficulty of demonstrating NIV benefits. Our aim was to assess the impact of NIV adherence on the rate of hospitalization for acute exacerbation and death.</p> </sec> <sec id="resp12327-sec-0002" sec-type="section"> <title>Methods</title> <p>This is a prospective multi‐centre cohort study of COPD patients treated by long‐term NIV. Comorbidities, anthropometrics, respiratory parameters were collected at inclusion in the study. Follow‐up data included vital status, NIV adherence and hospitalizations. The influence of NIV adherence on prognosis was tested using an adjusted Cox model. Sensitivity analyses for obese and non‐obese COPD subtypes were also conducted.</p> </sec> <sec id="resp12327-sec-0003" sec-type="section"> <title>Results</title> <p>Two hundred thirteen patients (48% obese) were included with 45.5% died during 47.7 [interquartile range = 27.8; 73] months' follow‐up. Survival was better in obese COPD than non‐obese COPD. The use of NIV > 9 h/day was associated with an increased risk of death or hospitalization for acute exacerbation [HR = 1.6; 95CI: 1.1–2.4]. In obese COPD, this risk described a U‐shaped curve from >1 to >9 h/day NIV usage with an improvement in prognosis when NIV adherence was > 5 h/day [HR = 0.5; 95CI: 0.2–0.9].</p> </sec> <sec id="resp12327-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Adherence to NIV was associated with better prognosis only in obese COPD. NIV use > 9 h/day predicted poor outcomes.</p> </sec> </abstract>