The use of non-invasive ventilation for the relief of dyspnoea in exacerbations of chronic obstructive pulmonary disease; A systematic review

Tracy A. Smith, Patricia M Davidson, Lawrence T. Lam, Christine R. Jenkins, Jane M. Ingham

Research output: Contribution to journalArticle

Abstract

Background and objective: Non-invasive ventilation (NIV) improves outcomes in patients with acute exacerbations of COPD (AECOPD); however, the efficacy in relieving dyspnoea is uncertain. The objective of this systematic review was to identify, synthesize and interpret the data regarding the relief of dyspnoea afforded by NIV in patients admitted with acute respiratory failure occurring during AECOPD. Methods: Randomized controlled trials (RCTs) comparing usual medical care (UMC) to UMC plus NIV and reporting dyspnoea as a patient-reported outcome were identified by searching relevant databases and manual searching. The full text of potentially relevant articles was retrieved. Data describing the impact of NIV on dyspnoea was extracted. Results: Four RCTs met the review criteria. One found NIV did not relieve dyspnoea. The other three RCTs reported NIV relieving dyspnoea. The degree of dyspnoea relief was clinically significant in two of these three studies. However, in all but one RCT, methodological or reporting limitations constrain the confidence that can be had in this conclusion. Conclusions: Limited data exist to determine if NIV relieves subjective dyspnoea in AECOPD. Due to limitations in these studies, it is not possible to definitively conclude if NIV relieves dyspnoea. Standardized reporting and analysis of patient reported outcomes will facilitate objective comparisons of interventions with respect to symptom relief. Future studies involving NIV should routinely incorporate patient reported outcomes in order to answer the important clinical question: 'Does NIV relieve dyspnoea?' Patient with AECOPD are usually dyspnoeic. This systematic review asks: 'Does NIV relieve dyspnoea in AECOPD?' The data contained in the four RCTs meeting inclusion criteria was insufficient to reach a definitive conclusion. An increased focus on patient reported outcomes is essential if this important question is to be answered.

Original languageEnglish (US)
Pages (from-to)300-307
Number of pages8
JournalRespirology
Volume17
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

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Noninvasive Ventilation
Dyspnea
Chronic Obstructive Pulmonary Disease
Randomized Controlled Trials
Respiratory Insufficiency

Keywords

  • chronic obstructive pulmonary disease
  • dyspnoea
  • non-invasive positive pressure ventilation
  • respiratory insufficiency
  • review
  • systematic

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

The use of non-invasive ventilation for the relief of dyspnoea in exacerbations of chronic obstructive pulmonary disease; A systematic review. / Smith, Tracy A.; Davidson, Patricia M; Lam, Lawrence T.; Jenkins, Christine R.; Ingham, Jane M.

In: Respirology, Vol. 17, No. 2, 02.2012, p. 300-307.

Research output: Contribution to journalArticle

Smith, Tracy A. ; Davidson, Patricia M ; Lam, Lawrence T. ; Jenkins, Christine R. ; Ingham, Jane M. / The use of non-invasive ventilation for the relief of dyspnoea in exacerbations of chronic obstructive pulmonary disease; A systematic review. In: Respirology. 2012 ; Vol. 17, No. 2. pp. 300-307.
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