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Randomised controlled trial
Non-invasive positive pressure ventilation should be considered in patients with COPD and persistent hypercapnia at least 2 weeks after resolution of acute respiratory failure
  1. Magnus Ekström
  1. Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
  1. Correspondence to Dr Magnus Ekström, Department of Medicine, Blekinge Hospital, Karlskrona SE-37185, Sweden; pmekstrom{at}

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Commendary on: Murphy PB, Rehal S, Arbane G, et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial. JAMA 2017;317:2177–86.

Implications for practice and research

  • Non-invasive positive pressure ventilation (NPPV) should be considered in patients with chronic obstructive pulmonary disease (COPD) with persistent hypercapnia 2–4 weeks after resolution of acute respiratory failure.

  • Timely follow-up after hospitalisation for acute respiratory failure is important.

  • Further trials are needed to confirm the findings and to clarify which patients benefit most, the role of concurrent obstructive sleep apnoeas and optimal ventilator settings of NPPV in stable hypercapnic COPD.


NPPV improves outcomes and should be standard care in patients with acute hypercapnic respiratory failure, indicated by respiratory acidosis, in COPD.1

Chronic hypercapnia is …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.