Is respiratory failure in patients of post-tuberculosis COPD less responsive to non-invasive ventilation?

Chronic obstructive pulmonary disease (COPD) represents a heterogeneous condition with varying etiological backgrounds. Present study aimed to compare the clinical features, effectiveness of non-invasive ventilation (NIV-BiPAP) and outcome of respiratory failure, among patients with post-infectious (COPD-I) versus environmental (COPD-E) etiotypes.

This comparative observational study was conducted on 120 respiratory failure patients of COPD, divided into two etiotype groups as, COPD-I with post-tubercular etiology and COPD-E with environmental exposure etiology. Patients of both groups were monitored and compared for clinical features, effectiveness of NIV (BiPAP) on basis of arterial blood gas (ABG) parameters and 12-h outcome.

Apart from body weight, analysis of demographic features revealed no significant differences between groups, where COPD-I patients had significantly lower body weight (45.94 kg vs 48.81 kg, p = 0.014). Both groups showed improvement in respiratory parameters over 12 h. ABG analysis demonstrated correction of respiratory acidosis with pH improving from acidosis (7.28-7.39 in COPD I; 7.25 to 7.38 in COPD E) and PaCO₂ levels reducing from hypercapnic values, (69-52 mmHg in COPD I; 72 to 48 mmHg in COPD E). Hemodynamic improvement was observed in both the groups with no significant intergroup variation. Clinical improvement was observed in 90.32 % of COPD-I and 98.27 % of COPD-E patients, with intubation rates of 9.67 % and 1.72 % respectively (p = 0.063).

NIV has comparable effectiveness and outcome in respiratory failure patients of both COPD etiotypes. Both groups showed equally effective response to NIV therapy, supporting its use as first-line treatment, regardless of COPD etiology.