BiPAP: Helping You Live Longer & Better with COPD
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People with severe COPD are now living better and longer than ever before. One reason for this accomplishment is the use of BiPAP both in hospitals and at home.

So, what is BiPAP, and how might it benefit you?

Here’s all you need to know:

What is BiPAP?

It’s an acronym for Bilevel Positive Airway Pressure. Like CPAP, It’s a form of Non-invasive Ventilation (NIV), meaning the pressure is applied by wearing a mask. The mask is connected to tubing that is connected to a machine. Like CPAP machines, BiPAP machines are small, easy to operate, and are relatively quiet. They offer pressure above what is in room air to help you breathe easier while sleeping or during flare-ups.

What’s the difference between CPAP and BiPAP?

CPAP applies a continuous pressure during inhalation and exhalation. This pressure acts as a “splint” to keep airways open when you exhale. This prevents soft tissue in your upper airway from collapsing and causing sleep apnea. It also keeps alveoli open so the next breath comes easier (kind of like blowing up a balloon that has already been blown up a few times). This helps keep your oxygen levels from dropping while sleeping. CPAP also reduces blood return to your heart so it doesn’t have to work as hard to pump blood through your body. So, CPAP can also be useful for treating heart failure, which is diagnosed in about 20% of COPD patients.

On the other hand, BiPAP offers two different pressures, one during exhalation called EPAP, and another during inhalation called IPAP.

What is EPAP and IPAP?

These are the two pressures BiPAP machines offer.

  • EPAP. This is an acronym for Expiratory Positive Airway Pressure. It’s basically the same thing as CPAP, only it’s called EPAP when referring to BiPAP machines. The difference in name is not meant to be confusing. In fact, quite the opposite. It’s meant so that when you say “EPAP” people know you’re referring to BiPAP machines, and when you say “CPAP” people know you’re referring to CPAP machines. But, essentially, they are the same thing. So, everything I wrote about CPAP above applies with BiPAP too. What’s unique to BiPAP machines is they also provide IPAP.
  • IPAP. This is an acronym for Inspiratory Positive Airway Pressure. It’s basically a pressure to assist with inhalation. Sometimes it’s referred to as pressure support. It supports or assists your effort to inhale to assure you take in breaths deep enough to effectively oxygenate and blow off carbon dioxide (a waste product of cellular respiration). It reduces the work you have to do to inhale, thereby making each breath come easier.

What are the benefits of BiPAP?

Some people with COPD have trouble inhaling against the CPAP, especially when the required setting is high. So, the addition of an inspiratory pressure makes inhaling easier. Some people with severe COPD don’t breathe effectively when sleeping. So, the addition of inspiratory pressure supports breathing. The machines can also sense when you’re not breathing, and force you to take in a breath, thereby preventing apnea episodes.

Can I use BiPAP at home?

Like CPAP machines, BiPAP machines can be used in the home setting. It has to be prescribed by a doctor, and usually involves participating in a sleep study. It is usually only needed at night time, or when you are sleeping.

What does the research show about home BiPAP?

It has long been suspected that daily use of BiPAP while sleeping improves the quality of life, and the length of life, for people living with severe COPD. Not only that, it also reduces hospital admissions due to flare-ups, and improves outcomes and reduces lengths of stays, for those who do require hospital admissions.

Is BiPAP used in the hospital setting to treat COPD flare-ups?

Sometimes. If you come to the emergency room with an exacerbation of COPD, doctors might order for you to try BiPAP. This works great for COPD exacerbations because it reduces the work you have to do to inhale, thereby making breathing easier. It also allows your muscles of inspiration and heart to relax, thereby preventing you from pooping out. This buys time for your caregivers to work their medicinal magic to get you feeling better.  As noted above, BiPAP can help both improve your oxygenation levels and normalize your carbon dioxide levels. So, it is a very nice tool for treating COPD in the clinical setting.

What do the studies show about hospital BiPAP?

Studies show that using BiPAP for those presenting to emergency rooms with severe COPD flare-ups significantly reduces the need for more invasive therapies, such as intubation and mechanical ventilation. It greatly improves outcomes and reduces the length of hospital admissions for those with COPD.

Will I tolerate home BiPAP?

While it may feel a little awkward at first, modern advancements in BiPAP therapy have greatly improved ease of use and comfort for patients.  In other words, improvements have greatly improved patient compliance.

Conclusion

Not every person with COPD needs BiPAP, and most certainly not every person who would benefit from it will tolerate it. However, for those who do, there is increasing evidence to show that BiPAP may help people with COPD live well for a long time.

view references
  1. Kacmarek, Robert M., James K. Stoller, Albert J. Heuer, “Egan’s Fundamentals of Respiratory Care,” 10th edition, 2013, Elsevier Mosby, pages 1134-5
  2. “Non-Invasive Ventilation in COPD Exacerbations,” Nursing Times, September 3, 2013, https://www.nursingtimes.net/clinical-archive/respiratory/non-invasive-ventilation-in-copd-exacerbations/5062992.article
  3. Criner, Gerard J., Rodger E. Barnette, Gilbert E. D’Alonzo, editors, “Critical Care Study Guide: Text and Review,” 2nd edition, 2010, Springer
  4. Respiratory Therapy Magazine: Noninvasive BiPAP Systems May Help COPD Patients, January 28, 2015, http://www.rtmagazine.com/2015/01/noninvasive-bipap-systems-may-help-copd-patients/, accessed 3/31/17
  5. Maclntyre, Neil R., “Mechanical Ventilation: Noninvasive Strategies in the Acute Care Setting,” Medscape, http://www.medscape.org/viewarticle/450209, accessed 3/31/17
  6. Ankjærgaard, Kasper Linde , et al., "Home Non Invasive Ventilation (NIV) treatment for COPD patients with a history of NIV-treated exacerbation a randomized, controlled, multi-center study," BMC Pulmonary Medicine, 2016, http://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-016-0184-6, accessed 4/1/17
  7. Respiratory Therapy Magazine: Nocturnal BiLevel Ventilation for the COPD patient," February 7, 2007 http://www.rtmagazine.com/2007/02/nocturnal-bilevel-ventilation-for-the-copd-patient/, accessed 4/1/17
  8. Lainscak, Mitja, Stefan D. Anker, "Heart failure, chronic obstructive pulmonary disease, and asthma: numbers, facts, and challenges," ESC Heart Failure, volume 2, issue 3, 2015, pages 103-107, http://onlinelibrary.wiley.com/doi/10.1002/ehf2.12055/pdf, accessed 4/2/17
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