Original Article

CME Article: Clinical Outcomes of Noninvasive Ventilation in Asthma, Bronchiectasis, and Other COPD

Authors: Christopher Nemeh, MD, Deepa Dongarwar, MS, Emmanuella Oduguwa, BS, Hamisu M. Salihu, MD, PhD, Jairo Barrantes Perez, MD


Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and disability worldwide. Use of noninvasive ventilation (NIV) appears to be associated with a significant decrease in frequency of exacerbation, hospital admissions, and mortality in patients with COPD. In this study, we sought to determine clinical outcomes, prevalence, patient profiles and systems characteristics associated with the use of NIV in patients with asthma, bronchiectasis, and other COPD.

Methods: In this retrospective study, the Nationwide Inpatient Sample dataset was used to evaluate patient characteristics for adult hospitalizations for asthma, bronchiectasis, and other COPD between January 2002 and December 2017. Using the adjusted survey logistic regression model, the association between NIV and in-hospital mortality for asthma, bronchiectasis, and other COPD was ascertained.

Results: Other COPD hospitalization prevalence was nearly two times higher among non-Hispanic Black patients compared with non-Hispanic White patients (8.32/1000 vs 4.46/1000). There was a 4.3% average annual decrease in the rates of NIV among hospitalized patients with other COPD during the study period. Furthermore, nonusage of NIV was associated with increased in-hospital mortality for asthma (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.50–1.57), bronchiectasis (OR 2.01, 95% CI 1.69–2.41), and other COPD (OR 1.24, 95% CI 1.16–1.32), respectively.

Conclusions: Inpatient use of NIV has a clear mortality benefit in asthma, bronchiectasis, and COPD. These findings support a signal for potential benefit, particularly among certain populations and warrant further investigation.
Posted in: Pulmonary Disease18

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 2017;5:691–706.
2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380: 2095–2128.
3. Wilson ME, Dobler CC, Morrow AS, et al. Association of home noninvasive positive pressure ventilation with clinical outcomes in chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA 2020; 323:455–465.
4. Gantzhorn EK, Prior TS, Hilberg O. Long-term non-invasive ventilation for stable chronic hypercapnic COPD. Eur Clin Respir J 2019;6:1644893.
5. Osadnik CR, Tee VS, Carson-Chahhoud KV, et al. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017;7: CD004104.
6. Ram FS, Picot J, Lightowler J, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2004;3:CD004104.
7. Budweiser S, Jörres RA, Riedl T, et al. Predictors of survival in COPD patients with chronic hypercapnic respiratory failure receiving noninvasive home ventilation. Chest 2007;131:1650–1658.
8. Ankjærgaard KL, Tønnesen P, Laursen LC, et al. Home non invasive ventilation (NIV) treatment for COPD patients with a history of NIV-treated exacerbation; a randomized, controlled, multi-center study. BMC Pulm Med 2016;16:32.
9. Duiverman ML, Vonk JM, Bladder G, et al. Home initiation of chronic noninvasive ventilation in COPD patients with chronic hypercapnic respiratory failure: a randomised controlled trial. Thorax 2020;75:244–252.
10. Coughlin S, Peyerl FW, Munson SH, et al. Cost savings from reduced hospitalizations with use of home noninvasive ventilation for COPD. Value Health 2017;20:379–387.
11. Tuggey JM, Plant PK, Elliott MW. Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis. Thorax 2003;58:867–871.