Home NIV for COPD May Prolong Life
Home NIV, which stands for “non-invasive ventilation,” is a method of treatment that can make breathing easier in certain people during end-stage COPD. COPD is a progressive, incurable disease that causes permanent damage to the lungs over time. Eventually, and this may take many years, the patient gets to the point where the lungs just do not work effectively at all.
When a person reaches that point, it is not uncommon to experience respiratory failure and a condition called hypercapnia. Hypercapnia occurs when your natural ventilation, or breathing, works so ineffectively that excess carbon dioxide builds up in the blood. It also means that not enough oxygen is getting into the lungs.
Who needs home NIV?
When you have COPD, your lungs and diaphragm lose their elasticity over time1. The lungs tend to be overinflated as well. Keep in mind that the job of the diaphragm, a large muscle under your lungs, is to help with expanding the ribcage and expanding the lungs during inhalation. Healthy lungs then help with exhalation.
But when your lungs and diaphragm are continually stretched out, they cannot do their jobs. So, then other muscles, such as the ones between your ribs and in your neck, try to take up the slack. Unfortunately, they can only do so much, and breathing becomes inefficient. You will also start to feel short of breath.
And that is what leads to you not being able to get enough oxygen into the lungs, or enough carbon dioxide out of the lungs. Over time, this causes imbalances in your body that lead to respiratory failure. And that will usually lead to a visit to the emergency room and probably hospitalization for acute care.
Studies show that adding at-home positive pressure ventilation can aid in the work of breathing2. So adding NIV to the rest of the COPD care plan can improve quality of life, reduce flare-ups and decrease repeated hospitalizations.
It’s important to note that supplemental oxygen therapy can increase life expectancy in those who have COPD. It can also increase comfort. However, in the later stages of COPD, as the respiratory system becomes more inefficient, oxygen may not be enough. This is where non-invasive ventilation may help.
What Is NIV?
NIV, or non-invasive ventilation, has been used for many years to treat respiratory failure in hospitals and even long-term facilities. More recently, it has been gaining popularity as a long-term, at-home treatment for managing COPD and preventing exacerbations3. This is despite the fact that there is conflicting evidence4 as to its effectiveness in certain subsets of the COPD population5.
NIV is a form of positive pressure ventilation, that assists with moving air into and out of the lungs. Common forms are the CPAP and BiPAP machines. The newest generations are portable and not only use positive pressure, but also include supplemental oxygen. They use a mask that is strapped to the face, rather than a tube inserted in the throat.
A search in Google will quickly reveal that there are a number of companies making these advanced home ventilators and a variety of models. Some of them can automatically adjust to your breathing patterns and needs.
However, these machines do tend to be complicated to use and set up. So, it’s essential to work closely with a health care professional such as a respiratory therapist to get started and with ongoing maintenance. And then to follow up closely with your doctor to make sure your treatment goals are being met with the assistance of the NIV machine.
Although more research may still be needed, NIV appears to offer promising results to at least some people with COPD who have experienced severe enough flare-ups to land them in the hospital in respiratory failure. Clinicians have noted that nighttime use of NIV can improve daytime gas exchange6. If you are interested in exploring the usefulness of this therapy in your care, be sure to discuss it with your health care team.