Effect of home noninvasive positive pressure ventilation combined with pulmonary rehabilitation on dyspnea severity and quality of life in patients with severe stable chronic obstructive pulmonary disease combined with chronic type II respiratory failure: a randomized controlled trial.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that significantly affects patients' quality of life. Non-invasive positive pressure ventilation (NPPV) and pulmonary rehabilitation have both shown promise in improving symptoms and lung function in COPD patients. However, the combined effects of home-based pulmonary rehabilitation and NPPV on moderate to severe COPD patients remain unclear.

OBJECTIVE

This study aimed to evaluate the efficacy of home pulmonary rehabilitation combined with non-invasive positive pressure ventilation (CPRNG group) compared to conventional treatment (CTG group) in patients with moderate to severe COPD.

METHODS

A total of 269 patients with moderate to severe COPD were enrolled, with 137 patients in the CTG group and 132 in the CPRNG group. The primary outcome measures included the COPD assessment test (CAT) score, modified medical research council scale (mMRC) score, forced expiratory volume in one second (FEV₁) percentage, 6-min walk test, and arterial oxygen pressure (PaO₂). Secondary outcomes included various dimensions of quality of life (impact, symptoms, and activity) measured through patient-reported outcomes.

RESULTS

Baseline comparisons between groups showed no significant differences in sociodemographic characteristics, disease duration, or symptoms. The CPRNG group showed significant improvements compared to the CTG group in the CAT score (p = 0.028), mMRC score (p = 0.015), FEV1% (p = 0.008), 6-min walk test (p = 0.001), and PaO₂ (p < 0.001). Additionally, improvements in impact, symptoms, activity, and overall scores were significantly better in the CPRNG group (p < 0.05).

CONCLUSIONS

Home pulmonary rehabilitation combined with non-invasive positive pressure ventilation significantly improves multiple dimensions of quality of life, particularly in controlling symptoms and enhancing daily activities in COPD patients. This combined therapy proves to be an effective treatment strategy, offering notable benefits in lung function, exercise capacity, and overall quality of life in COPD patients.

TRIAL REGISTRATION

The clinical trial was registered retrospectively on the Chinese Clinical Trial Registry (ChiCTR, www.chictr.org.cn ID: ChiCTR2500096605) on 2025-01-26, as required by The Fourth Hospital of Institutional (Changsha Fourth Hospital, Hunan Province, China) Review Board guidelines. Ethics approval date: January 2023 to December 2025.