What is the role of noninvasive ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD)?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
  • Print


Patients with underlying chronic obstructive pulmonary disease (COPD) who present with an exacerbation of their COPD and hypercapnic respiratory distress or respiratory failure are the group most likely to be successfully treated with noninvasive ventilation (NIV). Exacerbations increase the work of breathing in these patients and may exceed the patient's ability to adequately ventilate through a variety of mechanisms, including increasing hyperinflation with decreased diaphragmatic excursion and strength, increasing intrinsic positive end-expiratory pressure (PEEP), ineffective or inadequate tidal volume generation, respiratory patterns, and increased respiratory frequency. Noninvasive ventilation effectively unloads the respiratory muscles, increasing tidal volume, decreasing the respiratory rate, and decreasing the diaphragmatic work of breathing, which translates to an improvement in oxygenation, a reduction in hypercapnia, and an improvement in dyspnea.

Noninvasive ventilation is an important adjunct to other conventional therapy (eg, bronchodilators, corticosteroids, antibiotics). COPD is an ideal condition for noninvasive ventilation, given the rapid reversibility with treatment and added support that can be provided by noninvasive ventilation. Most experience with noninvasive ventilation has accrued with either bilevel positive airway pressure (BiPAP) or pressure support ventilation, less so with volume ventilation and continuous positive airway pressure (CPAP), which is infrequently used as a mode of ventilatory support in these patients.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!