Impact of outpatient adaptation to home mechanical ventilation (HMV) in health-related quality of life (HRQoL) of severe hypercapnic chronic obstructive pulmonary disease (COPD)

Historically, the initiation of HMV in patients with COPD occurred during an inpatient period. In the last years, there has been increasing interest in outpatient management, driven by the increasing number of patients and economic restrictions. This study aimed to evaluate the impact of outpatient initiation of HMV on HRQoL in patients with COPD. We conducted a prospective observational study in an Outpatient Ventilation Clinic of a tertiary hospital in Portugal. Severe COPD patients with symptoms of chronic respiratory failure with daytime pCO2≥50 mmHg in stable condition or persistent hypercapnia ≥53 mmHg >14 days following an exacerbation with mechanical ventilation were included. The Severe Respiratory Insufficiency (SRI) questionnaire was answered before and after 3-months of HMV. High overall score and in each of the 7 domains indicates good HRQoL and 5 units have been described as the minimal clinically important difference (MICD). Fifty-three patients (74% male, median 71p25-p75 61-77years) with median post bronchodilation FEV1 of 3529-40% and baseline pCO2 of 5452-57mmHg were included. After 3 months of HMV, patients improved their HRQoL (pre 59.1±18.2, post 64.8±16.6, p=.001). Differences were also observed in the domains respiratory complaints (difference 8.7, p<.001), attendant symptoms and sleep (8.2, p=.004) and social relationships (6.0 p=.007). At 3 months patients presented a median HMV usage of 74-8hours and pCO2 of 4846-50mmHg. Initiation of HMV in the outpatient setting significantly improves COPD patients' HRQoL above the estimated MCID for the SRI.