From the Guidelines
Discontinuing BiPAP therapy against medical advice for a COPD patient on home oxygen can significantly increase the risk of mortality, morbidity, and severely impact quality of life. According to the American Thoracic Society clinical practice guideline 1, long-term noninvasive ventilation, such as BiPAP, has been shown to improve physiological parameters, clinical symptoms, and patient-centered outcomes in stable patients with COPD and chronic hypercapnia. Without BiPAP support, the patient may experience worsening nocturnal hypoxemia, which could lead to pulmonary hypertension or right heart failure over time.
Some possible outcomes of quitting BiPAP use include:
- Worsening sleep quality, causing daytime fatigue, cognitive impairment, and reduced quality of life
- Increased risk of COPD exacerbations requiring hospitalization, as BiPAP helps reduce the work of breathing and clears carbon dioxide
- Development of respiratory acidosis due to carbon dioxide retention, particularly during sleep when respiratory drive naturally decreases
- Accelerated decline in lung function, increased mortality risk, and greater oxygen dependency
The use of "high-intensity" NIV, which refers to inspiratory pressures higher than those used in most previous randomized controlled trials, has been shown to maximally reduce the Pa CO2 and improve outcomes in patients with COPD and chronic hypercapnia 1. It is crucial for patients to continue BiPAP therapy as prescribed and discuss any concerns or comfort issues with their healthcare provider to ensure optimal management of their condition.
From the Research
Possible Outcomes of Quitting BiPAP Use
- Increased risk of respiratory failure due to untreated hypercapnia and hypoxemia 2
- Higher likelihood of hospitalization and emergency department visits due to exacerbations of COPD 3, 4, 5, 6
- Accelerated decline in lung function, reduced functional status, and decreased quality of life 3
- Increased mortality risk due to untreated COPD exacerbations and respiratory failure 3, 6
- Potential for increased healthcare costs due to increased hospitalizations, emergency department visits, and medical interventions 4, 5
COPD Management and BiPAP Use
- BiPAP is commonly used in COPD patients to manage respiratory failure and improve oxygenation 2
- COPD patients on BiPAP may experience improved lung function, reduced symptoms, and enhanced quality of life 3, 4, 5, 6
- Quitting BiPAP use without medical supervision may lead to a reversal of these benefits and increased risk of adverse outcomes 2