Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone after a COPD exacerbation
HOT-HMV trial design and results
Design
Randomised clinical trial
Treatment
Home oxygen plus home non-invasive ventilation
Control
Home oxygen alone
Population
116 patients with persistent hypercapnia after a COPD exacerbation; mean age 67, 53% female, mean FEV1 0.6 L, mean PaCO2 on air 59 mmHg
Follow-up
12 months
Primary endpoint
Time to readmission or death within 12 months
Result
Median time to readmission or death was 4.3 months (IQR 1.3 to 13.8) with home oxygen plus non-invasive ventilation versus 1.4 months (IQR 0.5 to 3.9) with oxygen alone. Sixty-four of 116 patients completed the 12-month period.
Secondary endpoints
Admission rate, mortality, exacerbation frequency, quality of life
Among patients with persistent hypercapnia following an acute exacerbation of COPD, adding home noninvasive ventilation to home oxygen therapy prolonged the time to readmission or death within 12 months.
The trial authors, in the published abstract
How it has aged
Defines the group that benefits from home ventilation: persistent hypercapnia two to four weeks *after* an exacerbation, not during it. Earlier trials failed largely by enrolling patients whose hypercapnia would have resolved anyway. Together with Kohnlein 2014 it made home ventilation a standard option in severe COPD.
Publications
Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial
Murphy PB, Rehal S, Arbane G, et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. JAMA 2017 Jun 6;317(21):2177-2186.
Median time to readmission or death 4.3 versus 1.4 months
Enrolled only patients with persistent hypercapnia after an exacerbation
Substantial attrition, with 64 of 116 completing 12 months