Adding home noninvasive ventilation to home oxygen therapy delayed deaths and hospital readmissions among hypercapnic patients with chronic obstructive pulmonary disease (COPD), according to results from a multicenter, randomized controlled trial known as HOT-HMV.
Positive results from the trial were presented September 6 during the 2016 European Respiratory Society International Congress in London. The HOT-HMV trial studied 116 patients with COPD who were hypercapnic—that is, had high carbon dioxide levels in their blood—and who were hospitalized after their COPD worsened. The study assessed whether adding home noninvasive ventilation to home oxygen therapy could improve the length of time these patients went without dying or being readmitted to the hospital. Secondary outcomes included measurements of lung function and changes in health-related quality of life.
Patients in the study who received at-home noninvasive ventilation in addition to oxygen therapy had a 51% decreased risk of rehospitalization or death, compared to those who received oxygen therapy alone (hazard ratio, 0.49; 95% confidence interval, 0.31–0.77; P = 0.002). Patients who received noninvasive ventilation at home went a median of 4.3 months without dying or being admitted to the hospital, compared to 1.4 months for those who did not receive noninvasive ventilation.
"These study results add further weight to the existing evidence supporting the broader use of noninvasive ventilation for patients living with COPD. The results strengthen arguments for a pivotal study in the area," said ResMed Chief Medical Officer Glenn Richards, MD. "In particular, the results are important because they show giving patients with hypercapnic COPD a noninvasive ventilation device for use in the home can very significantly cut their risk of rehospitalization and death after an acute worsening of the disease."
"Today, nearly one in four patients with COPD in the United States will be rehospitalized following an acute exacerbation, significantly impacting patients' quality of life and driving increased costs to health care systems and payers," Dr. Richards said. To curb the financial impact of COPD, the Centers for Medicare and Medicaid Services has started penalizing hospitals that have high readmission rates after an acute exacerbation of COPD. "We hope these results will have a positive impact on current practice and encourage more health care professionals to consider the role of noninvasive ventilation in managing their COPD patients," Dr. Richards said.
COPD is a collection of lung diseases, including chronic bronchitis and emphysema. It is a progressive, fatal condition that is one of the leading causes of death worldwide. The Centers for Disease Control and Prevention estimates that COPD costs the United States $36 billion in direct and indirect costs.
Source: ResMed; September 6, 2016.