Noninvasive Ventilation as an Important Adjunct to an Exercise Training Program in Subjects With Moderate to Severe COPD

BACKGROUND: The primary objective of this study was to investigate whether noninvasive ventilation (NIV) can positively affect exercise capacity, maximum oxygen uptake (V̇_O2), and symptoms after a 6-week physical training program for subjects with moderate to very severe COPD.

METHODS: 47 subjects with COPD who were enrolled in a physical training program were randomized to either physical training alone or NIV + physical training (NIV-Physical training). Physical training consisted of dynamic aerobic exercises on a treadmill 3 times/week for 6 weeks, for a total of 18 sessions. NIV was titrated according to the subject's tolerance at rest and during exercise. Assessments included physiological responses and symptoms at the incremental cardiopulmonary exercise test peak and during submaximal exercise on a treadmill, 6-min walk distance, maximum inspiratory (P_Imax) and expiratory pressure (P_Emax), BODE index, and health-related quality of life.

RESULTS: 43 subjects completed the 6-week physical training program. Both groups improved 6-min walk distance, P_Imax, BODE index, and quality of life, and no differences were found between groups. However, significant improvements were observed for subjects in the NIVPhysical training group with regard to P_Emax, maximum V̇_O2, maximum metabolic equivalents, circulatory power, and maximum S_pO2.

CONCLUSIONS: A 6-week physical training program alone can improve tolerance for exercise and quality of life, in addition to reducing the risk of mortality. However, NIV associated with a physical training program was shown to have an additive beneficial effect on powerful prognostic markers (maximum V̇_O2 and circulatory power) and to reduce symptoms and improve oxygen saturation in subjects with moderate to very severe COPD.