Long‐term adherence with non‐invasive ventilation improves prognosis in obese COPD patients
Open accessAbstract
BACKGROUND AND OBJECTIVE: Long-term non-invasive ventilation (NIV) has become a widespread modality of treatment in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. However, benefits in terms of patient-related outcomes are still under debate. Both NIV adherence and heterogeneous responses in different COPD phenotypes may contribute to the difficulty of demonstrating NIV benefits. Our aim was to assess the impact of NIV adherence on the rate of hospitalization for acute exacerbation and death. METHODS: This is a prospective multi-centre cohort study of COPD patients treated by long-term NIV. Comorbidities, anthropometrics, respiratory parameters were collected at inclusion in the study. Follow-up data included vital status, NIV adherence and hospitalizations. The influence of NIV adherence on prognosis was tested using an adjusted Cox model. Sensitivity analyses for obese and non-obese COPD subtypes were also conducted. RESULTS: Two hundred thirteen patients (48% obese) were included with 45.5% died during 47.7 [interquartile range = 27.8; 73] months' follow-up. Survival was better in obese COPD than non-obese COPD. The use of NIV > 9 h/day was associated with an increased risk of death or hospitalization for acute exacerbation [HR = 1.6; 95CI: 1.1-2.4]. In obese COPD, this risk described a U-shaped curve from >1 to >9 h/day NIV usage with an improvement in prognosis when NIV adherence was > 5 h/day [HR = 0.5; 95CI: 0.2-0.9]. CONCLUSIONS: Adherence to NIV was associated with better prognosis only in obese COPD. NIV use > 9 h/day predicted poor outcomes.
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Only a few studies have paid attention to adherence to NIV in COPD people, and most focused only on early NIV failure or quantification of adherence.
“Nevertheless, only a few studies have paid attention to adherence to NIV in COPD people, and most of them have focused only on early NIV failure (33,34) or on the quantification of adherence (35).”
From Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. (2022) · cites this paper as [33]
The Introduction says earlier studies often reported adherence only as mean daily use, but this paper set out to assess the relationship between daily NIV use and clinical outcomes. The Discussion reports an association between adherence and hospitalization or death in obese COPD patients. Thus it addresses adherence, but citing it as a study focused only on quantifying adherence overstates its scope. (LLM, conf=0.88)
Experimental — accuracy not yet measuredVentilator settings are not easy to adjust and they influence sleep quality, which has spill-over effects on daytime life.
“Ventilator settings are not easy to adjust and they influence sleep quality, which has spill-over effects on daytime life [34, 35].”
From A psychological intervention to promote acceptance and adherence to non-invasive ventilation in people with chronic obstructive pulmonary disease: study protocol of a randomised controlled trial. (2017) · cites this paper as [34]
The Discussion says ventilator settings may be harder to adjust in non-obese COPD patients with poor respiratory function and possible hyperinflation, and may affect subjective sleep quality. It does not establish an effect on daytime life, and it presents the sleep-quality effect as a possibility rather than a demonstrated finding. No page number is available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPrevious studies suggest that COPD patients who clearly demonstrated a lower survival benefit from NIV usage exhibit worse average daily NIV adherence, because of the imbalance between the constraints that NIV imposes and the improvement that patients perceive in their condition.
“Previous studies suggest that COPD patients who clearly demonstrated a lower survival benefit from the NIV usage exhibit worse average daily NIV adherence, because of the imbalance between the constraints that NIV imposes and the improvement that patients’ perceive in their condition [34].”
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“Moreover, most of the previous studies suggested that the difficult adjustment of the ventilator settings and the influence of NIVon sleep quality with spillover effects on daytime life can have an impact on its usage (36,37).”
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Self-citation
- Authors
- Borel, J., Pepin, J., Pison, C., Vesin, A., Gonzalez‐Bermejo, J., Court‐Fortune, I., & Timsit, J.
- Affiliations
- Inserm (FR)
- INSERM Unit 1042 Grenoble Alpes University Grenoble France
- Intensive Care and Pneumology Unit Pitié‐Salpêtrière University Hospital Paris France
- Centre Hospitalier Universitaire de Saint-Étienne (FR)
- Intensive Care Unit, A Michallon University Hospital Grenoble France
- Venue
- Respirology
- Publisher
- Wiley
- Published
- 2014-06-09
- Volume
- 19
- Issue
- 6
- Pages
- 857-865
- ISSN
- 1323-7799 (ISSN-L)
- 1440-1843
- OpenAlex
- W1514781929
- Cited by
- 83
- References
- 30
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 10 · 2023: 10 · 2022: 6 · 2021: 6 · 2020: 7 · 2019: 5 · 2018: 11 · 2017: 7 · 2016: 3 · 2015: 5 · 2014: 5
- FWCI
- 5.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Respirology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- programme hospitalier de recherche clinique (API 26-07)
- The AGIR a dom Scientific Council, Grenoble France
- The ALLP Scientific Council, Lyon France
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- non-invasive ventilation, medication adherence, chronic obstructive pulmonary disease, obesity, chronic respiratory failure, mortality, prognosis, U-shaped curve, COPD phenotypes
- MeSH terms
- Aged, Female, Follow-Up Studies, Hospitalization, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Patient Compliance, Phenotype, Prognosis, Prospective Studies, Risk Factors, Time Factors, Cohort Studies, Comorbidity, Incidence, Survival Rate, Treatment Outcome, Pulmonary Disease, Chronic Obstructive, Continuous Positive Airway Pressure
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