Noninvasive ventilation in chronic respiratory failure: effects on quality of life

Background: Noninvasive ventilation (NIV) has been found to be an essential technique to treat chronic respiratory failure (CRF) resulting from restrictive thoracic disorders (RTD). The last decades were characterized by the expansion of NIV to treat patients suffering from various other conditions, such as chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS).

Objectives: The aim of this study was to evaluate the effect of NIV on health-related quality of life (HRQoL) of patients with CRF during 2 years and to identify parameters associated with changes in HRQoL.

Methods: Ninety-one patients with CRF [35 COPD; 17 RTD; 28 OHS; 11 neuromuscular diseases (NMD)] participated. HRQoL was assessed with the SF-36 questionnaire. Additional measurements included blood gases, pulmonary function tests, dyspnea, daytime sleepiness, exacerbations and hospitalizations. The patients were evaluated every 3-6 months.

Results: Improvements in SF-36 physical component summary (PCS, p < 0.0001) and mental component summary (MCS, p < 0.0001) scores in RTD and MCS in OHS (p = 0.01) and COPD (p = 0.003) were observed by the third month. PCS in OHS and COPD patients improved by the sixth month (p = 0.003 and p < 0.0001, respectively). NMD patients did not present improvements in HRQoL. Improvements in HRQoL were associated with improvements in PaO(2) and dyspnea in COPD patients, and with total hours of daily ventilator use, improvement in dyspnea, pressure support and expiratory positive airway pressure in RTD patients.

Conclusion: Home NIV is consistently effective in improving HRQoL and physiological parameters in patients with CRF. Randomized trials to identify subgroups of COPD responders are justified by our results.