Aim: To evaluate the safety and efficacy of initiation of chronic NIV in patients with severe COPD and chronic hypercapnic respiratory failure.

Method: All patients had a pH >7.35, pCO2 > 6.0kPa and confirmed COPD (FEV1/FVC<70%). Respiratory nurse specialist (RNS) home-visits allowed NIV (BiPAP A30, Philips Respironics) set-up. Data sent to the online platform (Encore Anywhere, Philips Respironics) guided ventilator setting changes and were made remotely. Subsequent home-visits for repeat blood gas sampling or mask adjustment were dependent on response and compliance. Retrospective analysis of the recorded outcomes was undertaken.

Results: 30 patients (15 male), mean age 67 years (SD 12.13), mean FEV1 33% predicted (SD 11.31). Mean baseline pH 7.39 and pCO2 7.72kPa. 3 month pCO2 6.67kPa (p=0.001) and 6 month 6.37kPa (p<0.001). Hospitalisation and length-of-stay reduced in the 12 months after NIV initiation: mean 1.2 admissions before, 0.6 after (p<0.05), and mean 7.5 inpatient days to 4.8 days (p=N.S). All but one patient tolerated NIV and this failed due to claustrophobia. 2 patients died within 3 months of treatment.

Conclusion: Home initiation of chronic NIV in patients with severe COPD and chronic hypercapnic respiratory failure is both safe and effective.