Abstract
This document summarizes the work of the COPD Technical Expert Panel working group. For patients with COPD, the most pressing current coverage barriers identified were onerous diagnostic requirements focused on oxygenation (rather than ventilation) and difficulty obtaining bilevel devices with backup rate capabilities. Because of these difficulties, many patients with COPD were instead sometimes prescribed home mechanical ventilators. Critical evidence supports changes to current policies, including randomized controlled trial evidence suggesting a mortality benefit from bilevel positive airway pressure with backup rate and updated clinical practice guidelines from the American Thoracic Society as well as the European Respiratory Society. To achieve optimal access to noninvasive ventilation for patients with COPD, we make the following key recommendations: (1) removal of the need for overnight oximetry testing; (2) the ability to initiate therapy using bilevel devices with backup rate capability; and (3) increased duration of time to meet adherence criteria (ie, a second 90-day trial period) in those patients actively engaged in their care. Clear guidelines based on medical necessity are also included for patients who require initiation of or switch to a home mechanical ventilator. Adoption of these proposed recommendations would result in the right device, for the right type of patient with COPD, at the right time. Finally, we emphasize the need for adequate clinical support during initiation and maintenance of home noninvasive ventilation in such patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | e389-e397 |
| Journal | CHEST |
| Volume | 160 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2021 |
Funding
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: N. S. H. has had research contracts to his institution from and consults for Fisher Paykel and Philips Respironics. He also does consulting for Breas, Inogen and Invent Medical. G. J. C. has received grant support with monies that went to Temple University from Resmed, Philips Respironics and Fisher Paykel and has received consulting fees from Resmed, Philips Respironics and Fisher Paykel. R. D. B. receives consulting fees from Mallinckrodt, Pfizer, Ventec Life Systems, Vyaire, and ZOLL Medical Corporation, and stock ownership in Ventec Life Systems. N. R. M. serves as a consultant to Inspirx, Hillrom, and Ventec. None declared (B. R. C. A. S.). ∗ONMAP Technical Expert Panel members: Overall Chairs: Peter C. Gay, MD, FCCP, and Robert L. Owens, MD. Thoracic Restrictive Disorders: Chair/Co-Chair—Lisa F. Wolfe, MD, FCCP, and Joshua O. Benditt, MD, FCCP. Thoracic Restrictive Disorders Committee Members—Loutfi S. Aboussouan, MD, FCCP, John M. Coleman III, MD, and Dean R. Hess, PhD, RRT. COPD: Chair/Co-chair—Nicholas S. Hill, MD, FCCP, and Gerard J. Criner, MD, FCCP. COPD Committee Members—Richard D. Branson, MSc, RRT, Bartolome R. Celli, MD, FCCP, Neil R. MacIntyre, MD, FCCP, and Amen Sergew, MD. Central Sleep Apnea: Chair/Co-Chair—Timothy I. Morgenthaler, MD, and Atul Malhotra, MD, FCCP. Central Sleep Apnea Committee Members—Richard B. Berry, MD, Karin G. Johnson, MD, and Marc I. Raphaelson, MD. Hypoventilation: Chair/Co-chair—Babak Mokhlesi, MD, FCCP, and Christine H. Won, MD. Hypoventilation Committee Members—Bernardo J. Selim, MD, FCCP, Barry J. Make, MD, FCCP, and Bernie Y. Sunwoo, MBBS. OSA: Chair/Co-chair—Nancy A. Collop, MD, Master FCCP, and Susheel P. Patil, MD, PhD. OSA Committee Members—Alejandro D. Chediak, MD, FCCP, Eric J. Olson, MD, and Kunwar Praveen Vohra, MD, FCCP.
Keywords
- COPD
- hypercapnic respiratory failure
- mechanical ventilation
- noninvasive ventilation
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine