Effect of Oxygen Therapy Alone VS Home Non-Invasive Ventilation with Oxygen Therapy on Morbidity and Mortilty after an Acute Exacerbation of COPD

Abstract

Objective: To compare the effects of home non-invasive ventilation with oxygen therapy versus oxygen

Therapy alone on patients of acute exacerbation of COPD

Study design: A Randomized Controlled Trial.

Place and Duration of Study: Department of Pulmonology Nishtar Hospital Multan from April 2016 to march 2018.

Methodology: A total of 194 patients were divided into two groups of 100 and 94. There were 100 patients who were randomized to home oxygen alone. The number of patients who were given oxygen therapy with non invasive ventilation was 94. The non invasive ventilation was applied according to preference of patients by using nasal or total face masks. To increase the oxygen level to 60 mmHg, oxygen therapy was started at the minimum flow rate in both groups. The patients who were on oxygen therapy alone were instructed to undergo at least 15 hours of oxygen therapy daily. For the patients of other group, a minimum of 6 hours nightly use of ventilator was instructed.

Results: Ninety four patients were put on oxygen therapy combined with non-invasive ventilation and 100 patients were put on just oxygen therapy. Both the groups were comparable in all baseline variables. After one year follow up, there was significant improvement in PaCO2, PaO2, St. George Respiratory Questionnaire summary score and Severe Respiratory Insufficiency Questionnaire summary score at most of the occasions (p-value <0.001 for all at 3 months; .060, .013, .527 and .002 at 6 months; and .011, .001, .002 and .090 at 12 months, respectively).

Conclusion: It can be concluded from this study that the amount of time it takes to be readmitted to the hospital or suffer death from acute exacerbation in patients suffering from COPD can be improved by adding non-invasive ventilation to the oxygen therapy.

Keywords: Chronic obstructive pulmonary disease (COPD), Non-invasive ventilation (NIV), Acute exacerbation of COPD.