In patients with stable hypercapnic COPD another good opportunity for HMV is its addition to pulmonary rehabilitation.  This Figure shows results of a study of nocturnal NIV in addition to pulmonary rehabilitation in hypercapnic COPD patients.^[8]  The left side of the Figure shows the change in HRQOL results from the SRI questionnaire for the domains respiratory complaints (RC), physical functioning (PF), attendant symptoms and sleep (AS), social relationships (SR), anxiety (AX), psychological well-being (WB) and social functioning (SF) summary score (SS).  This shows that rehabilitation alone is effective in improving HRQOL; however there was a further increase in HRQOL in the group receiving NIV in addition to pulmonary rehabilitation.  

In this study patients were treated with HMV with a mean IPAP of 20 mbar.  The right side of the Figure shows daytime PaCO₂ values at room air, showing that there was no change in PaCO₂ values over time in the group receiving rehabilitation alone, whereas the patients receiving rehabilitation plus nocturnal NIV significantly reduced their PaCO₂ values.