Chest
Respiratory Muscle Rest Using Nasal BiPAP Ventilation in Patients With Stable Severe COPD
Section snippets
Patient Selection
Seventeen outpatients with severe COPD were identified from the records of the pulmonary function laboratory at MetroHealth Medical Center. Severe COPD was defined as an FEV1 less than 50 percent of the predicted value or a ratio of FEV1 to forced vital capacity less than 55 percent of the predicted value. Patients were in stable condition at the time of study; all had had pulmonary function tests and arterial blood gas measurements performed within approximately the previous 12 months.
Demographics
The characteristics of the study group are shown in Table 1. There were six women and three men with a mean age of 62 years in the nasal BiPAP group, and five women and three men with a mean age of 68 years in the sham-BiPAP group. Mean FEV1 was 0.76 ± 0.08 L and 0.73 ± 0.06 L for the nasal BiPAP and sham-BiPAP treated groups, respectively.
Diaphragmatic EMG
The peak heights of the integrated EMG signals were averaged over five consecutive breaths before, and again, 1 min after initiation of BiPAP ventilation.
DISCUSSION
In this study, nasal pressure-support ventilation, delivered via the nasal BiPAP ventilatory system, administered for 2 h/d for 5 consecutive days, significantly reduced severity of dyspnea and improved distance walked in 6 min in outpatients with stable severe COPD.
CONCLUSIONS
In the present study, a sham control group was employed to reduce placebo effects. Functional impairment, exercise tolerance, and severity of dyspnea were assessed using several different objective scales designed for this purpose in an attempt to lessen inaccuracies associated with subjective reports by patients. In addition, the regimen of nasal BiPAP treatment used was well tolerated by our patients. Our results suggest that, at least in the short term, nasal pressure-support ventilation,
ACKNOWLEDGMENT
We thank Daniel Stofan, and Ylonne Watkins and Diane Delletro for expert technical and editorial assistance, respectively. No industry support was obtained for this study, except for loan of a nasal BiPAP, model S/T-D ventilatory support system (Respironics, Inc), the solicitation of which was initiated solely by the authors.
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Effects of bi-level positive airway pressure on ventilatory and perceptual responses to exercise in comorbid heart failure-COPD
2019, Respiratory Physiology and NeurobiologyCitation Excerpt :O’Donnell et al., 2014) The consequent improvement in neuromechanical coupling might be instrumental to decrease dyspnea and increase exercise tolerance. ( O’Donnell et al., 1999) (Ambrosino and Cigni, 2015) (O’Donnell et al., 1988) (Borghi-Silva et al., 2008) Thus, combining inspiratory to expiratory (i.e., bi-level) positive airway pressure (BiPAP™) (Renston et al., 1994)(Toledo et al., 2007) (Bittencourt et al., 2017) (Gomes Neto et al., 2017) might be more useful to prolong exercise duration in those with greater restriction to tidal volume expansion (comorbid HF−COPD) than in those with less ventilatory constraints (HF). To the best of the authors knowledge, no previous study has specifically addressed whether HF patients with COPD would derive great physiological (less inspiratory constraints) and sensory (less dyspnea) benefits from BiPAP™ than their counterparts without COPD.
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Manuscript received October 27, 1992; revision accepted August 30, 1993