Effect of portable non-invasive ventilation on exercise tolerance in COPD: One size does not fit all
•We report on how to select COPD patients likely to respond to portable NIV (pNIV) during intermittent exercise.•A third of patients did not improve dynamic hyperinflation (non-responders) with pNIV compared to pursed lip breathing (PLB).•Non-responders exhibited greater resting hyperinflation and t...
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| Published in | Respiratory physiology & neurobiology Vol. 277; p. 103436 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier B.V
01.06.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1569-9048 1878-1519 1878-1519 |
| DOI | 10.1016/j.resp.2020.103436 |
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| Abstract | •We report on how to select COPD patients likely to respond to portable NIV (pNIV) during intermittent exercise.•A third of patients did not improve dynamic hyperinflation (non-responders) with pNIV compared to pursed lip breathing (PLB).•Non-responders exhibited greater resting hyperinflation and tended towards worse spirometric measures compared to responders.•Exercise endurance was improved with pNIV compared PLB in responders but remained unchanged in non-responders.•Further studies in auto-adjusted ventilators are warranted in patients with severe COPD.
In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5 % of predicted resting inspiratory capacity with pNIV compared to PLB.
At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240 ± 40 mL, p = 0.001 greater using pNIV). 16/24 were DH responders (DH: 220 ± 50 mL, p = 0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65 ± 4% versus 56 ± 2%; p = 0.028) and did not improve exercise tolerance (pNIV: 30.9 ± 3.4 versus PLB: 29.9 ± 3.3 min; p = 0.603). DH responders increased exercise tolerance (pNIV: 34.9 ± 2.4 versus PLB: 27.1 ± 2.3 min; p = 0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p = 0.043).
Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted. |
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| AbstractList | In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5 % of predicted resting inspiratory capacity with pNIV compared to PLB. At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240 ± 40 mL, p = 0.001 greater using pNIV). 16/24 were DH responders (DH: 220 ± 50 mL, p = 0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65 ± 4% versus 56 ± 2%; p = 0.028) and did not improve exercise tolerance (pNIV: 30.9 ± 3.4 versus PLB: 29.9 ± 3.3 min; p = 0.603). DH responders increased exercise tolerance (pNIV: 34.9 ± 2.4 versus PLB: 27.1 ± 2.3 min; p = 0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p = 0.043). Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted. In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5 % of predicted resting inspiratory capacity with pNIV compared to PLB. At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240 ± 40 mL, p = 0.001 greater using pNIV). 16/24 were DH responders (DH: 220 ± 50 mL, p = 0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65 ± 4% versus 56 ± 2%; p = 0.028) and did not improve exercise tolerance (pNIV: 30.9 ± 3.4 versus PLB: 29.9 ± 3.3 min; p = 0.603). DH responders increased exercise tolerance (pNIV: 34.9 ± 2.4 versus PLB: 27.1 ± 2.3 min; p = 0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p = 0.043). Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted.In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5 % of predicted resting inspiratory capacity with pNIV compared to PLB. At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240 ± 40 mL, p = 0.001 greater using pNIV). 16/24 were DH responders (DH: 220 ± 50 mL, p = 0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65 ± 4% versus 56 ± 2%; p = 0.028) and did not improve exercise tolerance (pNIV: 30.9 ± 3.4 versus PLB: 29.9 ± 3.3 min; p = 0.603). DH responders increased exercise tolerance (pNIV: 34.9 ± 2.4 versus PLB: 27.1 ± 2.3 min; p = 0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p = 0.043). Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted. •We report on how to select COPD patients likely to respond to portable NIV (pNIV) during intermittent exercise.•A third of patients did not improve dynamic hyperinflation (non-responders) with pNIV compared to pursed lip breathing (PLB).•Non-responders exhibited greater resting hyperinflation and tended towards worse spirometric measures compared to responders.•Exercise endurance was improved with pNIV compared PLB in responders but remained unchanged in non-responders.•Further studies in auto-adjusted ventilators are warranted in patients with severe COPD. In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5 % of predicted resting inspiratory capacity with pNIV compared to PLB. At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240 ± 40 mL, p = 0.001 greater using pNIV). 16/24 were DH responders (DH: 220 ± 50 mL, p = 0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65 ± 4% versus 56 ± 2%; p = 0.028) and did not improve exercise tolerance (pNIV: 30.9 ± 3.4 versus PLB: 29.9 ± 3.3 min; p = 0.603). DH responders increased exercise tolerance (pNIV: 34.9 ± 2.4 versus PLB: 27.1 ± 2.3 min; p = 0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p = 0.043). Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted. |
| ArticleNumber | 103436 |
| Author | Alexiou, Charikleia Vogiatzis, Ioannis Lane, Nicholas D. Hartley, Tom Chynkiamis, Nikolaos Armstrong, Matthew Hume, Emily Snow, Lauren Bourke, Stephen C. |
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| Cites_doi | 10.1016/j.mcna.2012.04.011 10.1136/thx.2005.053470 10.1097/01.ccm.0000439501.43288.77 10.1183/09059180.00000210 10.1080/15412555.2019.1631776 10.1080/15412555.2017.1298582 10.1183/09031936.02.01152001 10.1183/13993003.00745-2015 10.1164/rccm.201310-1863PP 10.1164/ajrccm.155.2.9032194 10.4187/respcare.06787 10.3390/jcm8010094 10.1164/ajrccm.164.5.2012122 10.1378/chest.103.1.143 10.1249/00005768-198205000-00012 10.1016/j.resp.2019.04.008 10.1513/AnnalsATS.201312-438FR 10.1080/15412550701480455 10.1164/ajrccm.163.4.2007026 10.1164/rccm.201309-1634ST 10.1186/s40248-015-0008-1 |
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| Keywords | Exercise tolerance Non-invasive ventilation Pulmonary rehabilitation COPD |
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| SubjectTerms | COPD Exercise tolerance Non-invasive ventilation Pulmonary rehabilitation |
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| Title | Effect of portable non-invasive ventilation on exercise tolerance in COPD: One size does not fit all |
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