Exercise on non-invasive ventilation (NIV) in patients with severe chronic obstructive pulmonary disease (COPD): From hospital to home

Buchan, Kathryn

Abstract

Introduction: Patients with severe chronic obstructive pulmonary disease (COPD) experience breathlessness leading to exercise limitation and impacting on Quality of Life (QOL). Pulmonary rehabilitation (PR) may improve QOL, but those with the severest disease are frequently hospitalised and cannot readily access PR. Previous studies have trialled positive pressure as a means of relieving ventilatory load in one off exercise tests, allowing more severe COPD patients to exercise (Maltais, Reissman and Gottfried, 1995). Other studies have assessed either mixed pathology or stable COPD patients (Menadue, et al. 2010, Dyer et al. 2011). Therefore there was a need to investigate the feasibility of allowing patients with severe unstable COPD to exercise using Non-invasive ventilation (NIV) over time.
Aims: Primary: To evaluate the feasibility (including acceptability) of applying NIV during exercise in both the hospital environment and at home with patients who have severe COPD who had been hospitalised for an acute exacerbation with acidotic respiratory failure. Secondary: To identify any trends in quantitative outcome measures and to gather qualitative data to aid understanding of the patient experience of the trial.
Methods: A mixed methods approach was applied. Patients were recruited when medically stable and randomised into 3 limbs: 1. Standard Care; 2. Exercise on NIV in hospital and 3. Exercise on NIV in hospital and at home for 3 months. Blinding of the participants or researcher was not possible. Quantitative outcome measures were collated for all groups including: six minute walk test (6MWT); St George’s respiratory questionnaire (SGRQ); European quality of life - 5 Dimensions - 5 Levels (EQ-5D-5L); The London Chest Activity of Daily Living Questionnaire (LCADL); Borg breathlessness score (MBORG); Modified Medical Research Council (MMRC) dyspnoea score; activity levels (ActiCal monitor); self-reported medication use, access to healthcare and hospital admissions. Semi-structured interviews were performed with patients in limb 3 to assess acceptability.
Results: Sample size recruited for the trial was n=18. At the end of the trial n=15 remained (n=6 standard care, n=5 exercise on NIV in hospital and n=4 exercise on NIV in hospital and home). Three patients died during the trial. No other participants dropped out of the trial. All outcome measures were completed except the activity monitor (ActiCal). There was a trend for improvement in 6MWT, SGRQ, LCADL and EQ-5D-5L in the exercise on NIV from hospital to home group. The semi-structured interviews revealed that the trial was acceptable to the participants in the exercise on NIV in hospital and home group.
Conclusions: This novel trial has shown that it is feasible and acceptable to patients with severe COPD to exercise on NIV. A further multi-centre RCT is required to achieve sufficient numbers to detect statistical significance in the primary outcome of the 6MWT, to identify the clinical relevance of any changes, and to evaluate cost effectiveness.

• Thesis Type: Thesis
• Acceptance Date: Jan 29, 2016
• Publicly Available Date: Jun 7, 2019
• Keywords: chronic obstructive pulmonary disease, exercise, non-invasive ventilation
• Public URL: https://uwe-repository.worktribe.com/output/914739
• Award Date: May 1, 2017