Background: Tidal expiratory flow limitation (EFL) is common among COPD patients. Whether EFL changes during sleep and can be abolished during home ventilation is not known.
Methods: COPD patients considered for noninvasive ventilation used a ventilator which measured within-breath reactance change at 5 Hz (∆Xrs) and adjusted EPAP settings to abolish EFL. Participants flow limited (∆Xrs > 2.8) when supine underwent polysomnography (PSG) and were offered home ventilation for 2 weeks. The EPAP pressure that abolished EFL was measured and compared to that during supine wakefulness. Ventilator adherence and subjective patient perceptions were obtained after home use.
Results: Of 26 patients with supine EFL, 15 completed overnight PSG and 10 the home study. In single night and 2-week home studies, EFL within and between participants was highly variable. This was unrelated to sleep stage or body position with only 14.6% of sleep time spent within 1 cmHO of the awake screening pressure. Over 2 weeks, mean EPAP was almost half the mean maximum EPAP (11.7 vs 6.4 cmHO respectively). Group mean ∆Xrs was ≤ 2.8 for 77.3% of their home use with a mean time to abolish new EFL of 5.91 min. Adherence to the ventilator varied between 71 and 100% in prior NIV users and 36-100% for naïve users with most users rating therapy as comfortable.
Conclusions: Tidal expiratory flow limitation varies significant during sleep in COPD patients. This can be controlled by auto-titrating the amount of EPAP delivered. This approach appears to be practical and well tolerated by patients.
Trial Registration: The trial was retrospectively registered at CT.gov NCT04725500.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697433 | PMC |
| http://dx.doi.org/10.1186/s12931-021-01913-7 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Developing structured clinical review templates in an integrated respiratory team during COVID-19: a qualitative review.
Br J Nurs
January 2025
Respiratory Nurse Specialist, NHS Dumfries and Galloway, Dumfries.
Introduction: In response to the SARS-CoV-2 pandemic in March 2020 and required adherence to infection control measures and patient and staff safety, an integrated respiratory team (IRT) developed guideline-based templates to support the team in teleconsultation reviews of their patients. Patients had been diagnosed with sleep disordered breathing, chronic obstructive pulmonary disease, asthma, interstitial lung disease or had oxygen assessment needs.
Methods: Nine IRT members collaboratively developed content for the templates to assist in clinical reviews.
Epigenetic Inhibitors Differentially Impact TGF-β1 Signaling Cascades in COPD Airway Smooth Muscle Cells.
Cells
December 2024
School of Life Science, University of Technology Sydney, Ultimo, NSW 2007, Australia.
Chronic obstructive pulmonary disease (COPD) is characterized by progressive and incurable airflow obstruction and chronic inflammation. Both TGF-β1 and CXCL8 have been well described as fundamental to COPD progression. DNA methylation and histone acetylation, which are well-understood epigenetic mechanisms regulating gene expression, are associated with COPD progression.
View Article and Find Full Text PDFEvolution of Physical Self-Esteem During Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: An Observational Study.
Healthcare (Basel)
December 2024
Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, 1200 Brussels, Belgium.
: Patients with COPD have altered self-esteem, and good self-esteem promotes personal, health, and social success. Improving self-esteem could be a method for encouraging the maintenance of physical activity. Only one study has evaluated the effects of pulmonary rehabilitation (PR) on self-esteem in moderate COPD patients.
View Article and Find Full Text PDFBackground: Meta-analyses have suggested that the risk of cardiovascular disease events is significantly higher after a chronic obstructive pulmonary disease (COPD) exacerbation, but the populations at highest risk have not been well characterized to date.
Methods And Results: The authors analyzed the risk of atherosclerotic cardiovascular disease (ASCVD) hospitalizations after COPD hospitalization compared with before COPD hospitalization and patient factors associated with ASCVD hospitalizations after COPD hospitalization among 2 high-risk patient cohorts. The primary outcome was risk of an ASCVD hospitalization composite outcome (myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention, stroke, transient ischemic accident) after COPD hospitalization relative to before COPD hospitalization.
Introduction Chronic obstructive pulmonary disease (COPD) is a significant contributor to global morbidity and mortality. Despite well-established management protocols, treatment remains suboptimal due to high costs and mortality rates. This study aims to compare the impact of initial oxygenation status, Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF), and National Early Warning Score 2 (NEWS2) scores on management outcomes in COPD patients.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!