"How I do it": Home Non-Invasive Ventilation in COPD.

There is increasing evidence that long-term NIV (LT-NIV) can improve outcomes in individuals with severe, hypercapnic COPD. Though the evidence remains uncluear in some aspects, LT-NIV appears to be able to improve patient-related and physiological outcomes like dyspnea, FEV1, PCO2 , and also reduce rehospitalizations and mortality. Efficacy is generally associated with reduction in PCO2 . To achieve this, an adequate interface (mask) is essential, as are appropriate ventilation settings that target the specific respiratory physiology of COPD. This will ensure comfort, synchrony and adherence that will result in physiologic improvements. This article briefly reviews the newest evidence and current guidelines on LT-NIV in severe COPD. It describes a true case who benefitted from the therapy. Finally, it provides strategies for initiating and optimizing this LT-NIV in COPD, discussing high-pressure NIV, optimization of triggering and control of inspiratory time. As demand increases, clinicians will need to be familiar with this therapy, to reap its benefits, as inadequately adjusted LT-NIV will not be tolerated or effective.