Chronic Fatigue Syndrome Research Today is a free monthly online journal that collates and summarizes the latest research about Chronic Fatigue Syndrome, including details on myalgic encephalomyelitis (me), diagnosis, gradual and sudden onset.

Nocturnal noninvasive ventilation in addition to rehabilitation in hypercapnic COPD patients.

Duiverman ML, Wempe JB, Bladder G, Jansen DF, Kerstjens HA, Zijlstra JG, Wijkstra PJ

University Medical Center Groningen, University of Groningen, Netherlands.

Rationale: Long-term noninvasive positive pressure ventilation (NIPPV) might improve the outcomes of pulmonary rehabilitation in severe COPD patients with chronic respiratory failure. OBJECTIVE: To investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation as compared to pulmonary rehabilitation alone improves health-related quality of life, functional status, and gas exchange in COPD patients with chronic hypercapnic respiratory failure. Measurements: Seventy-two COPD patients were randomly assigned to nocturnal NIPPV in addition to rehabilitation (n=37) or rehabilitation alone (n=35). Before and after the 3-months intervention period outcome measures were assessed. RESULTS: The Chronic Respiratory Questionnaire total score improved 15.1 points with NIPPV + rehabilitation, compared to 8.7 points with only rehabilitation. The difference of 7.5 points was not significant (p=0.08). However, compared to rehabilitation alone, the difference in the fatigue domain was greater with NIPPV + rehabilitation (mean difference 3.3 points, p<0.01), as was the improvement in the Maugeri Respiratory Failure questionnaire total score (mean difference -10%, p<0.03) and its cognition domain (mean difference -22%, p<0.01). Furthermore, the addition of NIPPV improved daytime arterial carbon dioxide pressure (mean difference -0.3 kPa; p<0.01), and daily step count (mean difference 1269 steps/ day, p<0.01). This was accompanied by an increased daytime minute ventilation (mean difference 1.4 L; p<0.001). CONCLUSION: Noninvasive ventilation augments the benefits of pulmonary rehabilitation in COPD patients with chronic hypercapnic respiratory failure as it improves several measures of health-related quality of life, functional status, and gas exchange.

Published 19 August 2008 in Thorax.
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