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Day-to-Day Variability of Parameters Recorded by Home Noninvasive Positive Pressure Ventilation for Detection of Severe Acute Exacerbations in COPD

Authors Jiang W, Chao Y, Wang X, Chen C, Zhou J, Song Y

Received 30 December 2020

Accepted for publication 4 March 2021

Published 22 March 2021 Volume 2021:16 Pages 727—737


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Weipeng Jiang,1,* Yencheng Chao,1,* Xiaoyue Wang,1 Cuicui Chen,1 Jian Zhou,1 Yuanlin Song1– 5

1Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 2Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Shanghai, 200032, People’s Republic of China; 3National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200000, People’s Republic of China; 4Department of Pulmonary Medicine, Zhongshan Hospital, Qingpu Branch, Fudan University, Shanghai, 201700, People’s Republic of China; 5Department of Pulmonary Medicine, Jinshan Hospital of Fudan University, Shanghai, 201508, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yuanlin Song
Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, People’s Republic of China
Tel +86 21 64041990-2422
Fax +86 21 54961729
Email [email protected]

Background: Home noninvasive positive pressure ventilation (NPPV) can be considered not only as an evidence-based treatment for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients, but also as a predictor for detecting severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
Methods: In this retrospective observational study, we collected clinical exacerbations information and daily NPPV-related data in a cohort of COPD patients with home NPPV for 6 months. Daily changes in NPPV-related parameters’ variability prior to AECOPD were examined using two-way repeated measures ANOVA and individual abnormal values (> 75th or < 25th percentile of individual baseline parameters) were calculated during 7-day pre-AECOPD period. Multivariate logistic regression was used to identify the independent risk factors associated with AECOPD that then were incorporated into the nomogram.
Results: Between January 1, 2018, and January 1, 2020, a total of 102 patients were included and 31 (30.4%) participants experienced hospitalization (AECOPD group) within 6 months. Respiratory rate changed significantly from baseline at 1, 2 or 3 days prior to admission (p< 0.001, respectively) in the AECOPD group. The number of days with abnormal values of daily usage, leaks, or tidal volume during the 7-day pre-AECOPD period in the AECOPD group was higher than in the stable group (p< 0.001, respectively). On multivariate analysis, 7-day mean respiratory rate (OR 1.756, 95% CI 1.249– 2.469), abnormal values of daily use (OR 1.918, 95% CI 1.253– 2.934) and tidal volume (OR 2.081, 95% CI 1.380– 3.140) within 7 days were independently associated with the risk of AECOPD. Incorporating these factors, the nomogram achieved good concordance indexes of 0.962.
Conclusion: Seven-day mean respiratory rate, abnormal values of daily usage, leaks, and tidal volume within the 7-day pre-AECOPD period may be biomarkers for detection of AECOPD.

Keywords: noninvasive positive pressure ventilation, day-to-day variability, detection, acute exacerbations of COPD

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