The Impact of Adherence to Non-Invasive Ventilation on Prognosis in Patients With Overlap Syndrome

This study aimed to investigate the impact of adherence to non-invasive ventilation (NIV) on the prognosis of patients with overlap syndrome (OS). This retrospective cohort study included 115 hospitalised patients with OS who initiated home NIV therapy and were followed up for 12 months. Adherence was classified as good (≥4 h/d) or poor (<4 h/d). Outcomes included annual exacerbation frequency, time to first exacerbation, severity of exacerbations, and St. George's Respiratory Questionnaire (SGRQ) scores. Initiating NIV treatment during hospitalisation was associated with a higher rate of NIV acceptance at home (33.99% vs. 11.34%, p < 0.001); however, there was no control group for treatment initiated on an outpatient basis. Good adherence significantly delayed the first acute exacerbation (log-rank test = 13.032, p < 0.001) and reduced the annual exacerbation rate (0.89 ± 0.86 vs. 1.24 ± 0.98, p = 0.041), but did not affect the severity of exacerbations. SGRQ scores at 6 and 12 months were better in the good adherence group (p < 0.05). There were no differences between groups in eosinophil counts or the use of benzodiazepines and opioids. This study demonstrates that good adherence to home NIV therapy following AECOPD significantly delays time to first exacerbation and reduces annual exacerbation frequency in patients with OS, while improving health-related quality of life. Additionally, in-hospital NIV initiation was associated with higher rates of home NIV acceptance compared to outpatient initiation, though this secondary finding requires prospective validation with appropriate comparator groups. These findings support the implementation of systematic screening and early intervention strategies for OS patients hospitalised for AECOPD.