A decade of domiciliary non-invasive ventilation in the west of Ireland.

BACKGROUND: While domiciliary non-invasive ventilation (NIV) was initially used in the treatment of respiratory failure resulting from chest wall deformity, the main indication is now chronic obstructive pulmonary disease (COPD) with recurrent exacerbations associated with type 2 respiratory failure. A longitudinal study of domiciliary NIV provides insights into the evolution of this treatment in the west of Ireland.

METHODS: The cohort of patients receiving new prescriptions for domiciliary NIV from Galway University Hospital from 2000 to 2012 was reviewed using study coordinator chart reviews and telephone follow-ups.

RESULTS: In total, 161 patients were identified. Prescriptions for domiciliary NIV increased from 2 in 2000 to 35 in 2012. The most common indication between 2000 and 2006 was obesity hypoventilation syndrome (OHS), changing to COPD between 2007 and 2012. There were significantly higher mortality rates in COPD and neuromuscular disease at 1- and 3-year follow-up compared to OHS and chest wall disease. Patients with chest wall disease had most survival years (7.33 ± 5.51) following initiation of domiciliary NIV when compared to patients with OHS (5.50 ± 3.70) and COPD (3.03 ± 1.89) and patients with neuromuscular disease (2.50 ± 2.01).

CONCLUSIONS: Domiciliary NIV use increased significantly in the West of Ireland from 2000 to 2012. There has been a shift in prescribing toward COPD. Survival rates for COPD on NIV are relatively short in contrast to patients with OHS and chest wall disease. Improved understanding of the benefits of NIV will allow physicians to better determine appropriate and cost-effective use in the future.