The Use of Noninvasive Ventilation for COPD

CPAP machine, a form of noninvasive ventilation
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What does it mean if your doctor recommends "noninvasive ventilation?" How does this differ from invasive ventilation? When are methods such as CPAP and BiPAP indicated and what are the benefits and risks of treatment?

What Is Noninvasive Ventilation?

Noninvasive ventilation is an alternative to invasive mechanical ventilation (being placed on a ventilator) for people who have chronic respiratory insufficiency or respiratory failure and can no longer breathe adequately on their own.

Also known as Noninvasive Positive Pressure Ventilation (NIPPV,) noninvasive ventilation assists a person in taking a full breath and helps to maintain an adequate oxygen supply to the body.

NIPPV provides ventilatory support to a person through the upper airways. It enhances the breathing process by providing a mixture of air and oxygen from a flow generator through a tightly fitted facial or nasal mask. Since the lungs are, in a way, held open by the positive pressure, it is easier to get oxygen down into the tiny alveoli where the exchange of oxygen and carbon dioxide take place.

In non-clinical terms, you may picture your alveoli as tiny balloons. Using this ventilatory support, the "balloons" stay slightly inflated after you breathe out so they are easier to expand with your next breath. In other words, it's like filling a balloon and being careful to not let all of the air out between breaths to make it easier to fill.

How Noninvasive Ventilation Is Used in COPD

People with chronic obstructive pulmonary disease (COPD) are sometimes prescribed noninvasive ventilation, such as CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure,) during exacerbations to help them breathe.

Typically associated with sleep apnea treatment, both CPAP and BiPAP deliver pressurized oxygen through an aim mask to the person's airways. The pressure prevents the throat muscles from collapsing and restricting airflow. CPAP machines are set to a single level of pressure that remains constant throughout the night, whereas BiPAP has two pressure levels, one for inhaling and one for exhaling.

The Effectiveness of Noninvasive Ventilation in COPD

A 2014 research paper published in Lancet found NIPPV improved survival rates in people with COPD. The yearlong randomized multicenter, multinational study found that people with COPD who received noninvasive ventilation had a 36 percent lower risk of death.

Other studies show that NIPPV used during acute COPD exacerbations reduces the need for endotracheal intubation (invasive mechanical ventilation,) and is associated with a lower rate of treatment failure and shorter hospital stays.

In addition, a 2016 study found that long-term NIPPV may result in improvements in arterial blood gasses (ABGs,) lung function and health-related quality of life. In general, these improvements were much better with high-intensity noninvasive ventilation (using the highest possible inspiratory pressure) than with low-intensity NIPPV.

When Noninvasive Ventilation Is Recommended

In people with COPD who are experiencing hypercapnic respiratory failure due to an acute COPD exacerbation, noninvasive positive pressure ventilation can be used in place of endotracheal intubation in select patients.

Your doctor may recommend NIPPV for you if you have moderate to severe dyspnea (the sensation of shortness of breath,) tachypnea (a rapid respiratory rate,) and hypercarbia (an elevated carbon dioxide level in the blood,) with a pH of between 7.25 and 7.35.

People should not be treated with NIPPV instead of mechanical ventilation if they are medically unstable because of hypotension (low blood pressure,) sepsis (a severe generalized infection that can lead to shock,) hypoxia (a deficiency in oxygen in the tissues of your body,) or other life-threatening systemic illness, have a worsening mental status, or are coping with excessive secretions which put them at a higher risk of aspiration.

Unlike invasive ventilation, which requires monitoring in the intensive care unit, noninvasive ventilation can frequently be performed in the general hospital ward, provide the staff is appropriately trained in its use.


Both CPAP and BiPAP deliver pressurized oxygen through a mask, though CPAP is set at a single constant measure whereas BiPAP has two settings, one for inspiration and one for expiration.

BiPAP is used more often for people with COPD since it is easier to exhale against a lower pressure. BiPAP also allows for adjustments in time.

The Bottom Line

Noninvasive ventilation is not appropriate for every person and is not always successful. Only your doctor can determine if you are a candidate for noninvasive ventilation.

That said, studies showing both the reduced need for endotracheal intubation and improved survival rates for people with COPD who are candidates for NIPPV are very encouraging. In addition, when looking at the long-term use of noninvasive ventilation with COPD, changes such as an improvement in blood gasses and lung function, as well as a better quality of life have recently been noted, particularly with high flow NIPPV.

Of course, non-invasive ventilation is only one measure of improving your quality of life and survival with severe COPD. Be sure to educate yourself on additional tips for retaining lung function with stage III COPD.

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