COPD treatment
Inhalers
Nocturnal NIPPV
- Casanove, CHEST 2000
- NIV improves quality of life, reduces CO2 retention, reduces dyspnea
- no change in mortality or hospitalization
- Murphy 2017:
- prolongs time to readmission or death for patients with persistent hypercapnia after hospitalization for exacerbation
- Struik 2013: no benefit in gas exchange, quality of life, lung function test in stable COPD
- Kohnlein 2014: Gold 4 pts with CO2 > 52 showed mortality benefit with IPAP 22 and rate 16
Obtaining NIV
- chronic hypercapnia: pCO2 > 52
- nocturnal hypoxemia: spO2 < 88 for > 5 min on 2L or patient's baseline O2
- documentation that sleep apnea has been considered or ruled out
Backlinks
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COPD
COPD
MISC
Epidemiology
- 5% of the U.S. population
Pathophysiology
- airflow obstruction that's not reversible
- inflammatory condition
- cigarette smoke/irritants activate macrophage/epithelial cells
- neutrophil chemotactic factors released
- proteases destroys lung parenchyma