Long-term ventilation is a recognised treatment for chronic hypercapnic respiratory failure, and is used to treat individuals with neuromuscular, intrapulmonary or restrictive aetiology. In England, exacerbations of chronic obstructive pulmonary disease (COPD) is the second most common cause of admission to hospital, with non-invasive ventilation (NIV) forming part of exacerbation management. Previous studies have advocated for at-home NIV in order to reduce admission rate, and as a result, demand for home-NIV has increased steadily year on year within our service. In general, patients are offered home NIV if they are recognised to have had multiple admissions due to exacerbations.

A retrospective service evaluation was performed to determine efficacy of at-home NIV for our patient population, to determine if previous positive large study findings were being replicated locally. In total, 72 service users were identified, 32 were excluded due to incomplete follow-up data or death of service user. The remaining 40 service users met the inclusion criteria and the 12-month period pre-NIV and post-NIV were assessed. Of these patients, 95% had COPD, with 2.5% also having Obstructive Sleep Apnoea and 2.5% also having Obesity Hypoventilation Syndrome. Mean number of admissions prior to NIV were 2, compared to mean admissions post-NIV of 0.5 (p<0.001), with an average exacerbation CO2 of 9.62kPa prior to NIV compared to 7.83kPa post-NIV (p<0.005). Length of stay and time between admissions were not impacted (p<0.173 and p<0.454 respectively). 

Overall, at-home NIV successfully reduces number and severity of admissions, benefitting service user health and burden on local health services.