Effect of portable non-invasive ventilation on exercise tolerance in COPD: one size does not fit all

During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip breathing (PLB) on exercise tolerance. Twenty-four COPD patients were randomised to a high-intensity (HI: 2-min at 80% peak work rate (WRpeak) alternated with 2-min recovery; n = 13), or a moderate-intensity (MOD: 6-min at 60% WRpeak alternated with 2-min recovery; n = 11) protocol, and within these groups two tests were performed using pNIV and PLB during recovery in balanced order. Upon completion, patients were provided with pNIV; use over 12 weeks was assessed. Compared to PLB, pNIV increased exercise tolerance (HI: by 5.2 ± 6.0 min; MOD: by 5.8 ± 6.7 min) (p < 0.05). With pNIV, mean inspiratory capacity increased and breathlessness decreased by clinically meaningful margins during recovery compared to the end of exercise (HI: by 140 ± 110 mL and 1.2 ± 1.7; MOD: by 170 ± 80 mL and 1.0 ± 0.7). At 12 weeks, patients reported that pNIV reduced anxiety (median: 7.5/10 versus 4/10, p = 0.001) and recovery time from breathlessness (17/24 patients; p = 0.002); 23/24 used the device at least weekly. pNIV increased exercise tolerance by reducing dynamic hyperinflation and breathlessness in COPD patients.

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Effect of portable non-invasive ventilation on exercise tolerance in COPD: One size does not fit all

Respiratory Physiology & Neurobiology ◽

10.1016/j.resp.2020.103436 ◽

2020 ◽

Vol 277 ◽

pp. 103436

Author(s):

Nikolaos Chynkiamis ◽

Matthew Armstrong ◽

Emily Hume ◽

Charikleia Alexiou ◽

Lauren Snow ◽

...

Keyword(s):

Exercise Tolerance ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

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Does the addition of non-invasive ventilation during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease augment patient outcome in exercise tolerance? A literature review

Physiotherapy Research International ◽

10.1002/pri.451 ◽

2009 ◽

Vol 15 (1) ◽

pp. 5-15 ◽

Cited By ~ 11

Author(s):

Eve Corner ◽

Rachel Garrod

Keyword(s):

Patient Outcome ◽

Chronic Obstructive Pulmonary Disease ◽

Literature Review ◽

Pulmonary Rehabilitation ◽

Exercise Tolerance ◽

Chronic Obstructive ◽

Invasive Ventilation ◽

Obstructive Pulmonary Disease ◽

Non Invasive ◽

Non Invasive Ventilation

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Non-invasive ventilation improves exercise tolerance and peripheral vascular function after high-intensity exercise in COPD-HF patients

Respiratory Medicine ◽

10.1016/j.rmed.2020.106173 ◽

2020 ◽

Vol 173 ◽

pp. 106173

Author(s):

Cássia da Luz Goulart ◽

Flávia Rossi Caruso ◽

Adriana S. Garcia de Araújo ◽

Guilherme Peixoto Tinoco Arêas ◽

Sílvia Cristina Garcia de Moura ◽

...

Keyword(s):

High Intensity ◽

Vascular Function ◽

Exercise Tolerance ◽

High Intensity Exercise ◽

Invasive Ventilation ◽

Peripheral Vascular ◽

Non Invasive ◽

Non Invasive Ventilation

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Improving Home Oxygen Therapy In Patients With Interstitial Lung Diseases (ILDs): Application Of A Portable Non-Invasive Ventilation (NIV) Device

10.21203/rs.3.rs-21270/v1 ◽

2020 ◽

Author(s):

Sandra Cuerpo ◽

Maria Palomo ◽

Fernanda Hernández-González ◽

Joel Francesqui ◽

Nuria Albacar ◽

...

Keyword(s):

Oxygen Saturation ◽

Exercise Tolerance ◽

Oxygen Therapy ◽

Arterial Oxygen Saturation ◽

Respiratory Muscles ◽

Interstitial Lung Diseases ◽

Arterial Oxygen ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Abstract Background: Proper adjustment of arterial oxygen saturation (SaO2) during daily activities in interstitial lung disease (ILD) patients requiring long-term oxygen therapy (LTOT) is challenging. Given the multifactorial nature of the limited exercise tolerance in patients with ILDs, the isolated use of oxygen therapy may not be enough. As demonstrated previously in COPD patients, the use of a portable non-invasive ventilation (NIV) device combined with oxygen therapy may prevent the falling of oxygen saturation during exercise, due to an increased activation of respiratory muscles that could lead to an improvement of exercise tolerance. We sought to assess in patients diagnosed with ILD who are in need of oxygen therapy, the effect of associating a portable NIV to improve oxygen parameters and the distance covered during the 6 minutes walking test (6MWT).Methods: We conducted a prospective observational study in patients with ILDs. After a clinical characterization, we performed 6MWT in two different situations: using a portable oxygen concentrator with the regular flow used by the patient during their daily life activities and afterwards adding the additional support of a NIV. The oxygen saturation parameters were registered with a portable oximeter. Results: We included 16 patients with different ILDs who have oxygen therapy prescribed. The use of NIV associated with oxygen therapy in comparison with the use of oxygen therapy alone showed an increase of the average SaO2 [91% (88-93) vs 88% (86-90); p=0.0005] and a decrease in the percentage of time with oxygen saturation<90% (CT90): 36% (6-56) vs 58% (36-77); p<0.0001. There were no changes in the 6MWT distance: 307m (222-419) vs 316m (228-425); p=0.10Conclusions: In our study the use of a portable NIV system associated with LTOT during exercise showed benefitial effects, especially improvement of oxygen saturation.

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Non invasive ventilation as an additional tool for exercise training

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2015.286 ◽

2015 ◽

Vol 10 ◽

Author(s):

Nicolino Ambrosino ◽

Paolo Cigni

Keyword(s):

Exercise Training ◽

Exercise Tolerance ◽

Ventilatory Support ◽

Invasive Ventilation ◽

Additional Tool ◽

Non Invasive ◽

Copd Patients ◽

Non Invasive Ventilation

Recently, there has been increasing interest in the use of non invasive ventilation (NIV) to increase exercise capacity. In individuals with COPD, NIV during exercise reduces dyspnoea and increases exercise tolerance. Different modalities of mechanical ventilation have been used non-invasively as a tool to increase exercise tolerance in COPD, heart failure and lung and thoracic restrictive diseases. Inspiratory support provides symptomatic benefit by unloading the ventilatory muscles, whereas Continuous Positive Airway Pressure (CPAP) counterbalances the intrinsic positive end-expiratory pressure in COPD patients. Severe stable COPD patients undergoing home nocturnal NIV and daytime exercise training showed some benefits. Furthermore, it has been reported that in chronic hypercapnic COPD under long-term ventilatory support, NIV can also be administered during walking. Despite these results, the role of NIV as a routine component of pulmonary rehabilitation is still to be defined.

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