Effective in exacerbations with hypercapnic respiratory failure

Papers p 185

Chronic obstructive pulmonary disease is a leading cause of global morbidity and mortality, and about 15% of adults in industrialised countries have chronic obstructive pulmonary disease when defined by spirometry. Mild exacerbations are common, and the development of hospital at home services for acute exacerbations has improved the treatment options for managing mild exacerbations safely in the community. Severe exacerbations, however, remain the largest single cause of emergency admissions for respiratory disease (far higher than for asthma), with a mean hospital stay of around 10 days. According to hospital episode statistics from the Department of Health, exacerbations of chronic obstructive pulmonary disease resulted in 135 000 admissions and just under a million bed days in England in 2000–1 (www.doh.gov.uk/hes). These account for over a third of the overall healthcare costs associated with treating chronic obstructive pulmonary disease in the United Kingdom. Exacerbations are not only expensive but can impair lung function and quality of life and are associated with further readmissions.

Severe exacerbations with impaired gas exchange are associated with death rates of up to 14%.1 In particular, admission to an intensive care unit and acute hypercapnic respiratory failure are associated with higher death rates—up to 59% at one year.2 …