FIG. 7: Thus the current situation represents a very common problem that is associated with significant morbidity and mortality. It is a problem that is very well treated with NIV in the acute setting, and therefore the question, empirically, is whether use of NIV in the home-care setting can improve outcomes in these patients. Thus the questions become: what is the evidence-base for the empirical observation, does the cost of this intervention outweigh any benefits, and is there a burden to the patient?

Home ventilation requires care for application of what in the healthcare setting is a relatively advanced technology to be initiated in the domiciliary setting. This means that the patients need to be able to perform the home application, and this requires input from the patient. The healthcare givers also need to think about whether home-based NIV is appropriate for all patients who have had acute exacerbations of COPD or whether there is only a select group of patients who would benefit from the addition of home ventilation.