Adding a noninvasive ventilator to home oxygen therapy prolonged the time to hospital readmission for patients with chronic obstructive pulmonary disease (COPD) after an acute exacerbation.
The study with the findings, titled “Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation, A Randomized Clinical Trial,” was published in the Journal of the American Medical Association (JAMA).
The results were also presented at the American Thoracic Society’s (ATS) 2017 Conference May 19-24 in Washington, D.C.
COPD is characterized by increasing breathlessness in which patients have recurrent exacerbations that can cause intermittent periods of severe clinical deterioration requiring hospitalization and ventilator support.
Although the treatment of patients with COPD and acute respiratory failure with noninvasive ventilation improves outcomes, persistent hypercapnia (high levels of carbon dioxide in the blood) after an exacerbation is associated with high mortality and early re-hospitalization.
Now, a team of U.K. experts led by researchers from the Lane Fox Respiratory Service based at Guy’s and St Thomas’ in London investigated hospital admissions and mortality and the effect of noninvasive ventilation added to home oxygen therapy in COPD patients. The clinical trial was called HOT-HMV (Home Oxygen Therapy-Home Mechanical Ventilation; NCT00990132).
The trial included 116 COPD patients who were divided into two treatment groups: home oxygen therapy alone (59 patients) or home oxygen plus home noninvasive ventilation (57 patients).
Researchers found that the addition of a home ventilator significantly delayed the time to hospital readmissions or death — 4.3 months in the group receiving home oxygen plus the ventilator compared to 1.4 months in the group receiving only oxygen therapy.
“The only current treatment we have to give these patients is oxygen therapy, but now we can give them oxygen as well as a ventilator in their home. We have managed to reduce the likelihood of readmission to hospital by almost 50%,” Prof. Nicholas Hart of Guy’s and St. Thomas’ NHS Foundation Trust and the study’s senior author, said in a news release.
“In the trial we used a home ventilator that coordinates itself with the individual patient’s breathing,” Hart said. “The mask ventilator machine works by blowing in air and oxygen to keep oxygen levels high and carbon dioxide, the waste gas, low.”
Ronnie Ward, 74, from Brighton, England, has had COPD for five years and uses his home ventilator every night. Since he participated in the trial, he and his wife Julie, 55, have made fewer trips to the hospital.
“Ronnie was in and out of hospital, sometimes spending weeks and months on the wards. Coming back and forth and spending so much time in hospital was stressful and very demoralizing,” Julie Ward said.
“We were finding that just weeks after he’d been discharged from hospital, Ronnie would need to be readmitted because he was struggling to breathe again. Using the breathing machine every night has taken a lot of pressure off us,” she added.
The team will continue to follow these patients and monitor their survival rates over the next three and five years.
“These results are extremely promising but the work will continue. So far we have found that patients using home oxygen with a home ventilator device are two-thirds less likely to be readmitted within 28 days,” Hart said.
“This is very important because not only does it maintain a patient’s quality of life but also it has the potential to significantly increase our ability to care for these patients without the need for a hospital stay,” he added. “At Guy’s and St Thomas’ around 1,000 patients are admitted each year with COPD. If we can keep them comfortable at home for longer, this will have a big impact.”
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