COPD is a disease often resulting from a combination of two different diseases, emphysema where there is damage to the air sacs (alveoli) in the lungs, and chronic bronchitis where there is inflammation of the airways.

It’s often, but not always, caused by smoking. The longer and more a patient smokes, the more chance they have of getting COPD – although not everyone is susceptible to the condition.

Most patients are older, although there is a condition called alpha antitrypsin deficiency disorder which is a rare condition that can cause COPD in younger patients, particularly those who smoke.

Symptoms include breathlessness and a chronic cough, and patients have a particular susceptibility to seasonal changes, i.e., in the winter COPD patients are more likely to pick up infections and experience progressive breathlessness, coughing and phlegm. However, symptoms vary from patient to patient so, for example, not everyone will cough up phlegm.

In COPD patients with chronic respiratory failure, HMV intervention can reduce hospitalisation risk and improve symptoms and quality of life in certain patient groups [1]. UK and international guidance now recommend that HMV be offered to appropriate patients with COPD. [2]

COPD Patient Stories:

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Questions to Ask Your Respiratory Team:

Please see below some examples of questions that you might want to ask your clinician.

  • What is HMV and how does it benefit patients with COPD?
  • Is it like acute ventilation?
  • How long will it take me to get used to it?
  • How long will I have to use it for?
  • How many hours a day will I need to use HMV?
  • Will it cure my COPD?
  • Will I have more energy?
  • Are there any side effects of using HMV?
  • Are there typical teething problems that I should be aware of?
  • What other therapies might I have to use alongside HMV to treat my COPD?
  • How can physiotherapy help?
Tailored Top Tips:

Some individuals, such as those with COPD, experience a period of breathlessness when switching off their ventilator. This may happen because of adapting to normal breathing again.

Holding the mask in place and gradually getting used to breathing over a few minutes with some breaths via the HMV and some without the ventilator can be of benefit. Also, some devices may have a ramp-down option to allow this to gradually take place.

If there is experience of breathlessness whilst using the HMV, or if it does not provide enough support, then the clinical team should be contacted. For issues that might relate to underlying medical condition(s), the patient’s GP or relevant clinical team should be contacted.

Supplementary Oxygen
Some patients with COPD are sensitive to oxygen and they may retain excess carbon dioxide if using too much oxygen. Clinical teams usually recommend that such patients aim for target oxygen saturations between 88% and 92%. If oxygen levels are too low, then this can cause concern. Some patients, therefore, require oxygen added to their NIV circuit overnight and may require oxygen during the day.

For patients using oxygen at home, a separate concentrator device is used to provide oxygen to the HMV circuit. The oxygen should not be left running through the HMV device when it is not in use. When turning off the HMV device, the oxygen concentrator should be switched off (or disconnect the oxygen if using oxygen alone during the day).

However, it is important to note that oxygen will be prescribed if required. It is not beneficial unless accompanied by low saturation levels.

Some patients with COPD also require oxygen therapy during the day to maintain oxygen saturations at their target level, again typically 88 – 92%. The clinical team will set the oxygen prescription. The term used to describe this type of oxygen therapy is ‘Long Term Oxygen Therapy.’ Most clinical teams refer to this as LTOT (pronounced L-tot). The oxygen settings (L/min) whilst using HMV might not be the same as the settings used when not using HMV.

[1] Murphy et al, Cost-effectiveness of home non-invasive ventilation in patients with persistent hypercapnia after an acute exacerbation of COPD in the UK