From the Guidelines
Increasing the IPAP to EPAP delta on BiPAP may help alleviate dyspnea in COPD patients.
Rationale
- The use of noninvasive positive pressure ventilation (NPPV) as an adjunct to pulmonary rehabilitation has been shown to be beneficial in reducing dyspnea and improving exercise tolerance in COPD patients 1.
- Higher positive pressures, as tolerated, may lead to greater improvements in symptoms and quality of life, suggesting that increasing the IPAP to EPAP delta could be beneficial 1.
- The goal of using NPPV is to provide inspiratory pressures of greater than 10 cm H2O, subject to patient tolerance, which may help to rest the respiratory muscles and improve symptoms 1.
- While the exact mechanism of how increasing the IPAP to EPAP delta affects dyspnea is not explicitly stated, the use of NPPV with higher positive pressures has been shown to augment the effects of an exercise program and improve symptoms in severe COPD patients 1.
- It is essential to note that NPPV should be used in a setting with significant experience in its use and in patients who have demonstrated benefit from this therapy, and further research is required to evaluate its cost-effectiveness and patient perception.
From the Research
Effects of IPAP to EPAP Delta on BiPAP in COPD Patients
- The current evidence does not directly address the effect of increasing the IPAP to EPAP delta on BiPAP in alleviating dyspnea in COPD patients 2, 3, 4, 5, 6.
- However, studies have investigated the effects of BiPAP and EPAP on respiratory mechanics and exercise tolerance in COPD patients.
- One study found that autotitration of EPAP using a forced oscillation technique (FOT) minimized transdiaphragmatic pressure swings and neural respiratory drive in patients with COPD and chronic respiratory failure 2.
- Another study compared the effects of BiPAP, pressure support, and CPAP on respiratory mechanics in COPD patients and found that BiPAP carried the risk of increased work of breathing 3.
- A study on the effects of EPAP during exercise on tolerance, dynamic hyperinflation, and dyspnea in COPD patients found that increasing intensities of EPAP tended to cause progressive reduction in exercise tolerance without improvement in dyspnea or dynamic hyperinflation 4.
- A protocol for a systematic review and meta-analysis aimed to determine the therapeutic efficacy of BiPAP in patients with type II respiratory failure due to acute exacerbation of COPD 5.
- A study on the effects of BiPAP on ventilatory and perceptual responses to exercise in comorbid heart failure-COPD found that BiPAP improved inspiratory capacity and reduced dyspnea scores at higher levels of ventilation 6.
Key Findings
- Autotitration of EPAP may minimize transdiaphragmatic pressure swings and neural respiratory drive in COPD patients 2.
- BiPAP may increase the work of breathing in COPD patients 3.
- EPAP during exercise may reduce exercise tolerance in COPD patients without improving dyspnea or dynamic hyperinflation 4.
- BiPAP may improve inspiratory capacity and reduce dyspnea scores in comorbid heart failure-COPD patients 6.