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ATS Issues Recommendations for Noninvasive Ventilation in COPD

Use of nocturnal NIV suggested as well as usual care for patients with chronic stable hypercapnic COPD

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FRIDAY, Sept. 18, 2020 (HealthDay News) -- In an official American Thoracic Society clinical practice guideline, published online Aug. 18 in the American Journal of Respiratory and Critical Care Medicine, recommendations are presented for the use of noninvasive ventilation (NIV) for patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia.

Madalina Macrea, M.D., Ph.D., M.P.H., from the University of California in San Diego, and colleagues developed recommendations regarding the use of NIV for patients with COPD and chronic hypercapnia.

For patients with chronic stable hypercapnic COPD, the authors suggest use of nocturnal NIV in addition to usual care. It is recommended that patients with chronic stable hypercapnic COPD undergo screening for obstructive sleep apnea before initiation of long-term NIV. Initiation of long-term NIV is not suggested during an admission for acute-on-chronic hypercapnic respiratory failure; instead, reassessment for NIV at two to four weeks after resolution is suggested. An in-laboratory overnight polysomnogram is not recommended for titrating NIV in patients with chronic stable hypercapnic COPD who are initiating NIV. In patients with hypercapnic COPD on long-term NIV, NIV with targeted normalization of partial pressure of carbon dioxide is advised.

"This guideline is needed now because studies in the last few years have shown improved outcomes with noninvasive ventilation for patients with severe COPD," a coauthor said in a statement. "The guideline incorporates recent studies, while also highlighting priority areas for research."

Several authors disclosed financial ties to the biopharmaceutical industry.

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