Home non-invasive ventilation in COPD: a global systematic review

Janine Dretzke, Jingya Wang, Mi Yao, Naijie Guan, Myra Ling, Erica Zhang, Deyashini Mukherjee, James Hall, Sue Jowett, Rahul Mukherjee, David J Moore, Alice M Turner

Research output: Contribution to journalReview articlepeer-review

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Abstract

Background: Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable chronic obstructive pulmonary disease (COPD) patients and those with a recent exacerbation (post-hospital). The aim of this systematic review was to: (1) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases, and (2) explore the impact of additional studies on the evidence base. Methods: Standard systematic review methodology was used for identifying and appraising studies. Randomized controlled trials (RCTs) and non-randomized studies reporting mortality, hospitalizations, exacerbations, quality of life, adverse events, or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalizations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from Western and non-Western countries. Results: A total of 103 studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomized studies, or RCTs from non-Western countries. There was a small but significant reduction in hospital admissions (1–2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China. Conclusion: The evidence base on home NIV is considerably larger than previously presented. While NIV may reduce hospital admissions and improve quality of life, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV.

Original languageEnglish
Pages (from-to)237-251
Number of pages15
JournalChronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
Volume9
Issue number2
Early online date8 Mar 2022
DOIs
Publication statusPublished - 29 Apr 2022

Keywords

  • COPD
  • Systematic review
  • home non-invasive ventilation
  • meta-analysis
  • systematic review

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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