Hypercapnic Chronic Obstructive Pulmonary Disease and Overlap Syndrome

The role of noninvasive ventilation (NIV) in hypercapnic chronic obstructive pulmonary disease (COPD) respiratory failure and overlap syndrome have been confusing over the last several years. In addition, if able to understand the timing and indications for NIV use, the clinical practice approach is riddled with hurdles to obtain in the United States. NIV for acute respiratory failure secondary to COPD exacerbation and NIV to prevent extubation failure in this patient population are not discussed here. Evidence for NIV in acute hospitalization is clearly accepted; however, bridging NIV from inpatient to home in hypercapnic COPD patients is a topic of debate, and a challenge for providers who are not experts in this space. This article discusses the evidence, interventions, timing, and insurance guidelines to assist health care providers.