Day-to-Day Variability of Parameters Recorded by Home Noninvasive Positive Pressure Ventilation for Detection of Severe Acute Exacerbations in COPD

Abstract

Background: Home noninvasive positive pressure ventilation (NPPV) can be considered not only as an evidence-based treatment for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients, but also as a predictor for detecting severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods: In this retrospective observational study, we collected clinical exacerbations information and daily NPPV-related data in a cohort of COPD patients with home NPPV for 6 months. Daily changes in NPPV-related parameters' variability prior to AECOPD were examined using two-way repeated measures ANOVA and individual abnormal values (>75th or <25th percentile of individual baseline parameters) were calculated during 7-day pre-AECOPD period. Multivariate logistic regression was used to identify the independent risk factors associated with AECOPD that then were incorporated into the nomogram. Results: Between January 1, 2018, and January 1, 2020, a total of 102 patients were included and 31 (30.4%) participants experienced hospitalization (AECOPD group) within 6 months. Respiratory rate changed significantly from baseline at 1, 2 or 3 days prior to admission (p<0.001, respectively) in the AECOPD group. The number of days with abnormal values of daily usage, leaks, or tidal volume during the 7-day pre-AECOPD period in the AECOPD group was higher than in the stable group (p<0.001, respectively). On multivariate analysis, 7-day mean respiratory rate (OR 1.756, 95% CI 1.249-2.469), abnormal values of daily use (OR 1.918, 95% CI 1.253-2.934) and tidal volume (OR 2.081, 95% CI 1.380-3.140) within 7 days were independently associated with the risk of AECOPD. Incorporating these factors, the nomogram achieved good concordance indexes of 0.962. Conclusion: Seven-day mean respiratory rate, abnormal values of daily usage, leaks, and tidal volume within the 7-day pre-AECOPD period may be biomarkers for detection of AECOPD.

Machine-learning based feature selection for a non-invasive breathing change detection

“…Some methods, based on self-reported symptoms or manually entered data [6][7][8][9][10] are limited, since they depend on subjective assessment and on patient compliance. Others have been focusing in remote monitoring devices, enabling automatic follow-up of physiological data and reducing the need for intervention for data acquisition by patients or the health team [11][12][13][14][15][16]. Some of the methods described employ an online learning process, that can be considered as a novelty detection approach.…”

“…In the case of exacerbation prediction, one frequent hypothesis is that changes in the breathing pattern may occur before exacerbation. More specifically, some authors have found that a significant change in breathing rate may be related to an exacerbation event [11,13,14,16].…”

“…Among the remote monitoring devices proposed, some have the particularity of being coupled with a non-pharmacological treatment. That is the case of some non-invasive ventilation (NIV) machines [11,14,16] that allow monitoring with minimal patient effort, since it only depends on patients treatment compliance. In the most recent of these studies, a model for prediction of exacerbations based only on the respiratory rate performed with 93.5% sensitivity and 64.8% specificity.…”

“…In the most recent of these studies, a model for prediction of exacerbations based only on the respiratory rate performed with 93.5% sensitivity and 64.8% specificity. The model performance was increased when combining breathing rate with other measures from NIV [16].…”

Effect of sitting and lying Liuzijue exercise for pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease patients with non-invasive ventilation: a randomized controlled trial

“…According to epidemiological investigation, 22-40% of COPD patients have moderate or severe exacerbation at least once a year (3). AECOPD refers to the acute exacerbation of respiratory symptoms in patients with COPD that requires additional therapy (5,6). Treatment of patients with AECOPD requires the use of bronchodilators, glucocorticoids, antibiotics, and other medications.…”