Addition of Home Noninvasive Ventilation Tied to Fewer Readmissions After COPD Exacerbation

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Adding home noninvasive ventilation to home oxygen therapy in certain patients with severe chronic pulmonary obstructive disease (COPD) is associated with lower risk for hospital readmission and death, according to a phase 3 JAMA study.

Nearly 120 patients with persistent hypercapnia and hypoxemia after an acute COPD exacerbation (daytime PaCO₂ greater than 53 mm Hg 2 weeks or more after acidemia resolution) were randomized to receive home oxygen therapy either alone or with home noninvasive ventilation.

The primary outcome — median time to readmission or death within 12 months — was significantly longer in the group that received noninvasive ventilation plus home oxygen therapy, compared with those who only received home oxygen (4.3 vs. 1.4 months). The difference was largely driven by readmission avoidance.

The authors say that for patients with persistent hypercapnia, home oxygen plus home noninvasive ventilation should be an option. Editorialists conclude: "This is a reasonable suggestion as long as patients with reversible hypercapnia are given sufficient time to recover (2–4 weeks after hospital discharge) and PaCO₂ levels remain substantially elevated."