Role of Noninvasive Positive Pressure Ventilation in Chronic Obstructive Pulmonary Disease

Since 1980, continuous positive airway pressure technology (CPAP) has been one of the most effective treatment methods for obstructive airway disease. About 10 years later, Bi-level Positive Airway Pressure (BiPAP) had been developed with a more beneficial concept. CPAP and BiPAP are the most common forms of noninvasive positive pressure ventilation (NIPPV). CPAP administrates a single, constant, low-pressure air to maintain airway expansion throughout the respiratory cycle, while BiPAP gives high and low levels of pressure; one during inspiration (IPAP) and another during expiration (EPAP) to regulate breathing pattern and to keep airways expanded. Recently, much evidence suggests NIPPV in form of CPAP or BiPAP as a treatment option for Chronic Obstructive Pulmonary Disease (COPD) to improve blood gas abnormality and to reduce mortality rate, as well as to decrease the requirement of invasive mechanical ventilation and hospitalization. A guide for health care professionals released in 2019 has confirmed the use of NIPPV in COPD patients during exacerbation and if combined with obstructive sleep apnea. However, the treatment of stable COPD patients with hypercapnia or post-hospitalization COPD patients due to exacerbation with long term home NIPPV has not yet been adopted. Thus, COPD patient status and the timing of NIPPV delivery should be clearly evaluated. This mini review aims to show the role of NIPPV technology as an additional treatment option for patients suffering from COPD.