Home Non-Invasive Ventilation in COPD: A Global Systematic Review.

Background Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable COPD patients and those with a recent exacerbation ('post-hospital'). The aim of this systematic review was to (i) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases and (ii) explore the impact of additional studies on the evidence base. Methods Standard systematic review methodology was used for identifying and appraising studies. Randomised controlled trials (RCTs) and non-randomised studies reporting mortality, hospitalisations, exacerbations, quality-of-life, adverse events or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalisations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from 'Western' and 'non-Western' countries. Results One hundred and three studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomised studies, or RCTs from 'non-Western' countries. There was a small but significant reduction in hospital admissions (1-2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China. Conclusions The evidence base on home NIV is considerably larger than previously presented. Whilst NIV may reduce hospital admissions and improve QoL, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV.