[Non invasive mechanical ventilation in the domiciliary treatment of chronic obstructive pulmonary disease].

Since hypercapnia is a negative prognostic index in stable chronic obstructive pulmonary disease (COPD), the chance of applying non invasive ventilation (NIV) to COPD with CO2 retention has been investigated for the two last decades. Patho-physiologic basis of its employ are resting of respiratory muscles and/or resetting of respiratory centres. Due to its poor tolerability, negative pressure NIV has been taken over by positive pressure technique. As the results of the few available controlled studies aren't enthusiastic and univocal, it's not possible to draw guidelines about the domiciliary use of NIV in COPD. In conclusion, the author suggests that, in order to avoid useless waste of resources, the application of NIV to stable COPD should be reserved to very selected cases (significant hypercapnia, frequent nocturnal desaturations and/or sleep disordered breathing and/or hospital admissions) if its compliance and effectiveness are demonstrated.