Home NIV in COPD- A treatment lag or an Opportunity?

Recent years have seen many positive updates in the medical management of COPD (Chronic Obstructive Pulmonary Disease). A lot has changed over the years and incorporated into the routine practices of physicians. Whereas the updates in the medical management have seen a very high acceptance among the fraternity the role of Home Ventilation has always been seen as a grey area.

Though the role of NIV (Non- invasive Ventilation) has been well established in the management of acute exacerbation of COPD, recently data has been coming forward for the usage & role of NIV in stable COPD patients and home mechanical ventilation. India has guidelines for Non Invasive ventilation in acute respiratory failure(1) but nothing similar exits for the NIV for chronic disease.

Estimates suggest there are 30 million COPD patients in India and it contributes a significant and growing percentage of COPD mortality which is estimated to be amongst the highest in the world (2). Although smoking remains the most significant risk factor for COPD, exposure to biomass fuels like crop residues or woods or animal dung also contributes a significant amount to the burden of the disease (3).

Although this is a large sect of population which requires proper evaluation and management, this also provides healthcare providers with an excellent opportunity in a country like India. Since healthcare facilities remain inadequate with both private sector and government hospitals remaining overwhelmed with the patient load, home NIV provides a natural solution. Patients who are suitable candidates for home NIV can be managed better and exhibit an improvement in QOL (Quality of Life). Home NIV also increases patient's involvement in his/ her care and empowers them to manage their disease better.

A lot of clinical evidence is required (in Indian context) and hopefully it will suggest and help physicians incorporate home ventilation in their practice. This will improve the healthcare outcomes for the patients and would also bring down the cost for the healthcare providers.

1.       Rajesh Chawla, G. C. Khilnani, J. C. Suri, N. Ramakrishnan, R. K. Mani, Shirish Prayag et al. Guidelines for noninvasive ventilation in acute respiratory failure. Indian J Crit Care Med April-June 2006 Vol 10 Issue 2

2.        Salvi S, Agarwal A. India needs a national COPD prevention and Control program. J Assoc Physicians India. 2012;60(Suppl):5–7.

3.       Singh S, Soumya M, Saini A, Mittal V, Singh UV, Singh V. Breath carbon monoxide levels in different forms of smoking. Indian J Chest Dis Allied Sci. 2011;53:25–8.