Long-term ventilation in obstructive ventilatory disorders

A large randomized, controlled study of NIV plus LTOT versus LTOT in patients with COPD is needed that evaluates morbidity, mortality, quality of life, and health economic impact. It is to be hoped that funding for this type of study will be forthcoming. In the meantime, it reasonably can be concluded from existing evidence that domiciliary NIV is unlikely to be effective in most patients with stable COPD, particularly if they are normocapnic. A subgroup of patients with severe hypercapnia, poor tolerance of LTOT, marked nocturnal hypoventilation, or recurrent infective exacerbations may benefit from domiciliary NIV. Systematic evaluation is required in patients with CF or bronchiectasis.