Efficacy of Nocturnal Nasal Ventilation in Stable, Severe Chronic Obstructive Pulmonary Disease During a 3-Month Controlled Trial
Section snippets
Patients And Methods
Study Population.— From our Pulmonary Function Laboratory archival database, we reviewed pulmonary function test results and ABG values from 1989 to 1992 that had been obtained during the patient's routine clinical assessment. After identifying those patients with severe COPD and hypercapnia, we further examined their medical records to find those with the following characteristics: (1) forced expiratory volume in 1 second (FEV1) of less than 40%/% predicted and consistent with severe airway
Results
Patient Contact.—We initially identified 85 patients with severe COPD and hypercapnia from our Pulmonary Function Laboratory database. Twenty-three records were discarded from the mailing because of psychiatric disorders (N = 7), nasal ventilator or continuous PAP use (N = 6), lung transplantation program (N = 4), active cancer (N = 4), and age 80 years or older (N = 2). Of the remaining 62 patients who were contacted by mail, 27 declined the opportunity to participate in the trial or did not
Discussion
The results of this trial suggest that disabled but otherwise stable patients with advanced COPD without evidence of sleep-disordered breathing are unlikely to benefit from NNV. Although these conclusions are based on a small sample size, we are confident about the findings because they conform with the clinical experience at most other medical centers.8,10 Several physiologic principles related to assisted ventilation in patients with severe but stable COPD without further severe nocturnal
Acknowledgment
We thank Lori L. Oeltjenbruns for assistance with preparation of the submitted manuscript.
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This study was supported in part by Grant MOl RR 00585 from the National Institutes of Health, Public Health Service, and the Mayo Foundation.