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Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients.
MedLine Citation:
PMID:  24912564     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Jean-Christian Borel; Jean-Louis Pepin; Christophe Pison; Aurélien Vesin; Jesus Gonzalez-Bermejo; Isabelle Court-Fortune; Jean-François Timsit
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-9
Journal Detail:
Title:  Respirology (Carlton, Vic.)     Volume:  -     ISSN:  1440-1843     ISO Abbreviation:  Respirology     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9616368     Medline TA:  Respirology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2014 Asian Pacific Society of Respirology.
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