Randomized controlled trial of domiciliary noninvasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease

The addition of noninvasive positive pressure ventilation (NPPV) to an exer cise training (ET) program in severe chronic obstructive pulmonary disease (COPD) may produce greater benefits in exercise tolerance and quality of li fe than after training alone. Forty-five patients with severe stable COPD-m ean (SD) FEV1 0.96 (0.31) L, Pa-O2 65.4 (9.07) mm Hg, Pa-CO2 45.6 (7.89) mm Hg-were randomized to domiciliary NPPV + ET (n = 23) or ET alone (n = 22), Exercise capacity and health status were assessed at baseline and after an 8-wk training program. There was a significant improvement in mean shuttle walk test (SWT) in the NPPV + ET group: from 169 (112) to 269 (124) m (p = 0.001), compared with the ET group: 205 (100) to 233 (123) m (p = 0.19); m ean difference (95% confidence interval [CI]): 72 (12.9 to 131) m. Repeated measures analysis of variance (ANOVA) showed that the differences between the two groups became evident only in the final 4 wk of the training progra m with a mean end study difference (95% 1CI) of 65.8 (17.1 to 114) m, There was a significant improvement in the Chronic Respiratory Disease Questionn aire (CRDQ) of mean (SD) 24.0 (17.4) (p = < 0.001) in the NPPV + ET group a nd 11.8 (15.8) (p = 0.003) points in the ET group; mean difference: 12.3 (1 .19 to 23.4). Only the NPPV + ET group demonstrated a significant improveme nt in arterial oxygenation; mean difference: 3.70 mm Hg (0.37 to 7.27), Thi s study suggests that domiciliary NPPV can be used successfully to augment the effects of rehabilitation in severe CORD.