Non-invasive positive pressure ventilation and exercise training in patients with stable hypercapnic chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a disease with progressive course of dyspnea which leads to reduced health related quality of life (HRQoL). Exercise training has useful effects toward their exercise tolerance and health related quality of life (HRQoL). However extreme breathlessness limits these patients in maintaining exercise training. Non-invasive positive pressure ventilation (NIPPV) is considered a beneficial treatment option for chronic stable hypercapnic respiratory failure. So, the aim of this study is to assess the effect of adding NIPPV to Exercise training program compared to Exercise training program alone in stable hypercapnic COPD patients. Patients and methods: Thirty patients with stable hypercapnic COPD were selected, subdivided into two groups; 15 patients underwent Exercise training alone (Ex. group) and another 15 patients performed Exercises training in association with receiving NIPPV (Ex. + NIPPV group). Baseline and after 3 months assessment of arterial blood gases analysis (ABGs), pulmonary function tests (PFTs), dyspnea scale by modified Medical Research Council (mMRC) and assessment of HRQoL guided by COPD Assessment Test (CAT) were done for both groups. Results: In the Exercise training group, they showed statistical significant improvement in dyspnea scale (mMRC) and CAT score after 3 month performance (p < 0.05), but insignificant changes occurred in their ABGs or PFTs (p > 0.05). While in the Ex. + NIPPV group, a highly statistical significant improvement regarding PCO2, FEV1 and dyspnea scale (mMRC) (p ⩽ 0.001) and a significant difference as regards HRQoL assessment score (p < 0.05) were found after 3 month follow up. Conclusion: Addition of NIPPV to exercise training in patients with stable hypercapnic COPD patients improved PCO2, FEV1, dyspnea scale and HRQoL