Home Respiratory Strategies in Patients With COPD With Chronic Hypercapnic Respiratory Failure

Area of Science:

• Respiratory Medicine
• Pulmonary Critical Care
• Medical Devices

Background:

• Home noninvasive ventilation (NIV) is recognized for improving chronic hypercarbia and outcomes in COPD patients.
• The effectiveness of home high-flow nasal cannula (HFNC) as an alternative to NIV remains uncertain.

Purpose of the Study:

• To compare the efficacy of home NIV and HFNC against standard care for adult COPD patients with chronic hypercapnic respiratory failure.
• To evaluate patient-important outcomes including mortality, exacerbations, hospitalizations, and quality of life.

Main Methods:

• A systematic search of multiple databases (MEDLINE, Embase, Cochrane CENTRAL, Scopus, ClinicalTrials.gov) was conducted up to March 31, 2023, with an update on July 14, 2023.
• A frequentist network meta-analysis of 24 randomized controlled trials (RCTs) involving 1,850 subjects was performed.
• The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Main Results:

• Both NIV and HFNC likely reduce COPD exacerbations compared to standard care (NIV RR 0.71; HFNC RR 0.77).
• NIV may reduce mortality risk versus standard care (RR 0.82), while HFNC's effect on mortality is uncertain (RR 1.20).
• HFNC probably improves quality of life (SGRQ score MD -7.01) and may reduce hospitalizations (RR 0.87) compared to standard care.

Conclusions:

• Both NIV and HFNC demonstrate efficacy in reducing exacerbation risks for COPD patients compared to standard care.
• HFNC presents potential advantages in enhancing patient quality of life, serving as a viable alternative to NIV.