High-intensity non-invasive ventilation during exercise-training versus without in people with very severe COPD and chronic hypercapnic respiratory failure: a randomised controlled trial.
complementary medicine
exercise
non invasive ventilation
pulmonary rehabilitation
Journal
BMJ open respiratory research
ISSN: 2052-4439
Titre abrégé: BMJ Open Respir Res
Pays: England
ID NLM: 101638061
Informations de publication
Date de publication:
22 11 2023
22 11 2023
Historique:
received:
26
06
2023
accepted:
29
09
2023
medline:
24
11
2023
pubmed:
23
11
2023
entrez:
22
11
2023
Statut:
epublish
Résumé
People with very severe chronic obstructive pulmonary disease (COPD) using nocturnal non-invasive ventilation (NIV) for chronic hypercapnic respiratory failure (CHRF) experience reduced exercise capacity and severe dyspnoea during exercise training (ET). The use of NIV during ET can personalise training during pulmonary rehabilitation (PR) but whether high-intensity NIV (HI-NIV) during exercise is accepted and improves outcomes in these extremely physically limited patients is unknown. The aim of this trial was to determine if ET with HI-NIV during PR was more effective than without at improving exercise capacity and reducing dyspnoea during exercise. Patients with COPD, CHRF and nocturnal-NIV were randomised to supervised cycle-ET as part of PR with HI-NIV or without (control). Primary outcome was change in cycle endurance time (ΔCET Twenty-six participants (forced expiratory volume in 1 s 22±7%pred, PaCO In this small group of patients with very severe COPD requiring nocturnal NIV, participation in an ET-programme during PR significantly improved exercise capacity irrespective of HI-NIV use. Reported dyspnoea was in favour of HI-NIV. NCT03803358.
Sections du résumé
BACKGROUND
People with very severe chronic obstructive pulmonary disease (COPD) using nocturnal non-invasive ventilation (NIV) for chronic hypercapnic respiratory failure (CHRF) experience reduced exercise capacity and severe dyspnoea during exercise training (ET). The use of NIV during ET can personalise training during pulmonary rehabilitation (PR) but whether high-intensity NIV (HI-NIV) during exercise is accepted and improves outcomes in these extremely physically limited patients is unknown. The aim of this trial was to determine if ET with HI-NIV during PR was more effective than without at improving exercise capacity and reducing dyspnoea during exercise.
METHODS
Patients with COPD, CHRF and nocturnal-NIV were randomised to supervised cycle-ET as part of PR with HI-NIV or without (control). Primary outcome was change in cycle endurance time (ΔCET
RESULTS
Twenty-six participants (forced expiratory volume in 1 s 22±7%pred, PaCO
CONCLUSION
In this small group of patients with very severe COPD requiring nocturnal NIV, participation in an ET-programme during PR significantly improved exercise capacity irrespective of HI-NIV use. Reported dyspnoea was in favour of HI-NIV.
TRIAL REGISTRATION NUMBER
NCT03803358.
Identifiants
pubmed: 37993279
pii: 10/1/e001913
doi: 10.1136/bmjresp-2023-001913
pmc: PMC10668250
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03803358']
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Thorax. 2013 Sep;68(9):887-8
pubmed: 23935174
Thorax. 2023 Apr;78(4):326-334
pubmed: 34656996
Clin Chest Med. 2014 Mar;35(1):51-69
pubmed: 24507837
COPD. 2005 Mar;2(1):105-10
pubmed: 17136970
Lancet Respir Med. 2014 Sep;2(9):698-705
pubmed: 25066329
Respir Res. 2021 May 4;22(1):138
pubmed: 33947416
Pneumologie. 2017 Nov;71(11):722-795
pubmed: 29139100
Respirology. 2019 Mar;24(3):195-196
pubmed: 30548957
Thorax. 2004 Jun;59(6):455-7
pubmed: 15170021
Health Qual Life Outcomes. 2008 Jul 02;6:46
pubmed: 18597689
Cochrane Database Syst Rev. 2014 May 14;(5):CD007714
pubmed: 24823712
Int J Chron Obstruct Pulmon Dis. 2019 Oct 18;14:2377-2384
pubmed: 31695357
Thorax. 2002 Oct;57(10):853-9
pubmed: 12324670
Chest. 2021 Dec;160(6):2066-2079
pubmed: 34224690
Respir Med. 2002 May;96(5):359-67
pubmed: 12113387
Eur Respir Rev. 2013 Jun 1;22(128):178-86
pubmed: 23728873
Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):880-5
pubmed: 10712337
Respirology. 2018 Feb;23(2):182-189
pubmed: 28940820
Clinics (Sao Paulo). 2007 Apr;62(2):113-20
pubmed: 17505694
Respir Care. 2022 May;67(5):543-552
pubmed: 35318238
Eur Respir J. 2007 May;29(5):930-6
pubmed: 17331969
Eur Respir J. 2007 Nov;30(5):993-1013
pubmed: 17978157
Eur Respir J. 2014 May;43(5):1326-37
pubmed: 24337043
Eur Respir J. 2008 Mar;31(3):667-77
pubmed: 18310400
J Heart Lung Transplant. 2012 Sep;31(9):934-41
pubmed: 22884381
Ann Am Thorac Soc. 2021 May;18(5):e12-e29
pubmed: 33929307
Eur Respir J. 2009 Aug;34(2):340-5
pubmed: 19251787
Respir Care. 2014 May;59(5):709-17
pubmed: 24149672
Eur Respir J. 1998 Aug;12(2):363-9
pubmed: 9727786
Ann Am Thorac Soc. 2021 Mar;18(3):395-398
pubmed: 33326340
Isr Med Assoc J. 2005 Mar;7(3):151-5
pubmed: 15792258
Chest. 2002 Aug;122(2):464-72
pubmed: 12171818
Respirology. 2019 Mar;24(3):254-261
pubmed: 30242790
Eur Respir J. 2006 Jan;27(1):65-72
pubmed: 16387937
Chest. 1998 Jun;113(6):1580-7
pubmed: 9631797
Respiration. 2018;96(1):66-97
pubmed: 29945148
COPD. 2005 Mar;2(1):81-9
pubmed: 17136967
JAMA. 2017 Jun 6;317(21):2177-2186
pubmed: 28528348