Ventilator-Assisted Living©

Summer 1999, Vol. 13, No. 2

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Noninvasive Positive Pressure Ventilation (NPPV) for People with COPD: A New Group of Ventilator Users

Chronic obstructive pulmonary disease (COPD) refers primarily to diseases characterized by airflow obstruction and airway inflammation, such as emphysema, bronchitis, and asthma. COPD differs from neuromuscular diseases and restrictive lung conditions, such as muscular dystrophy, ALS, post-polio, or scoliosis, in which the lungs are sound, but the problems are usually ones of respiratory and diaphragmatic muscle weakness, and chest wall stiffness.

Hypoventilation and hypercapnia may occur in people with either COPD or restrictive disorders. Assisted ventilation is generally used to manage this in people with neuromuscular and restrictive lung conditions. People with COPD who have hypoxemia are usually managed with long-term oxygen therapy, but now, some physicians are using nocturnal NPPV in combination with oxygen for people with COPD who are hypercapnic.

Pulmonologists are conducting studies to determine just how beneficial NPPV is for certain subsets of people with COPD, especially those with acute exacerbations or chronic hypercapnia. The point at which treatment with NPPV should be initiated in people with COPD has not been determined. Small studies have shown that NPPV is sometimes beneficial in selected people with stable COPD.

Many studies demonstrate that when acute respiratory failure occurs in people with COPD requiring hospitalization, about 60% can be successfully treated with NPPV, thereby avoiding intubation. The randomized studies of nasal ventilation with BiPAP; systems reported that compliance was a problem: often people with COPD do not tolerate NPPV with a nasal mask or pillows. Poor compliance may be a reason why long-term NPPV is unsuccessful.

The questions for IVUN are: Just who is a "ventilator user?" Should people with COPD who use NPPV be considered "ventilator users?" Do they face the same issues that people with neuromuscular disease face? Would ventilator users with neuromuscular disease benefit by networking with people with COPD and vice versa? Will this group enlarge the population of ventilator users and produce a larger "consumer" group with more clout? Anyone who wishes to respond should contact:

IVUN
4207 Lindell Boulevard, #110
Saint Louis, MO (Missouri) 63108-2915 USA
314-534-5070 fax, info@ventusers.org

References

ATS standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. (1995). American Journal of Respiratory and Critical Care Medicine, 152, S77-S120.

Hill, N.S. (1993). Noninvasive ventilation: Does it work, for whom, and how? American Review of Respiratory Disease, 147, 1050-1055.

Leger, P., Bedicam, J.M., Cornette, A., Reybet-Degat, O., Langevin, B., Polu, J.M., Jeannin, L., & Robert, D. (1994). Nasal intermittent positive pressure ventilation: Long-term follow-up in patients with severe chronic respiratory insufficiency. Chest, 105, 100-105.

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