Positive Airway Pressure Therapy Might Reduce COPD Hospitalizations, But Few Patients Receive It

Although studies show that continuous positive airway pressure (PAP) therapy can reduce hospitalizations among patients with chronic obstructive pulmonary disease (COPD), less than 8 percent of patients receive this treatment.

PAP is a treatment delivered by a device that gently forces pressurized room air through the airways to keep the passages open.

In a study titled “Positive Airway Pressure Therapies and Hospitalization in Chronic Obstructive Pulmonary Disease,” published in The American Journal of Medicine, researchers reviewed records of more than 1.8 million COPD patients to determine how common PAP therapy is, and how its use impacts hospitalization rates.

Researchers found that only 7.5 percent of the COPD patients analyzed received some form of PAP therapy. Among them were 48,856 who received either bi-level, continuous, or noninvasive positive pressure ventilation therapy. These patients had lower rates of hospitalizations compared to the period before they started PAP therapy, as well as compared to patients who were not receiving PAP therapy.

The lower risk for hospital admission varied with the type of PAP therapy used, and ranged between 81 percent for noninvasive positive pressure ventilation, through 58 percent for bi-level positive airway pressure, to 30 percent with continuous positive airway pressure, when comparing the six months before and after the start of PAP treatment.

If patients also had other health conditions, including sleep apnea, chronic respiratory failure, or heart failure, the benefits provided by PAP treatment were even greater.

“Frequent readmissions of COPD patients not only disrupt their quality of life, but are costing our health systems billions,” Sairam Parthasarathy, senior author of the study, said in a press release. Parthasarathy is a professor of medicine and interim chief of the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the University of Arizona College of Medicine.

“This analysis revealed that there is a solution already accessible within our toolbox that can keep patients out of the hospital, but it is significantly underutilized. With improved awareness and implementation of PAP therapy as a treatment for COPD, we can lower the cost burden for health systems while allowing patients to recover in the comfort of their own homes,” said Parthasarathy.

However, researchers emphasized that more analysis is needed to understand the relationship between PAP therapy and hospital admissions.

Philips, a developer of PAP therapy solutions, funded this study. Recently, the company also sponsored two additional studies evaluating hospitalization among COPD patients. One study reported that advanced home noninvasive ventilation, specifically Trilogy with AVAPS-AE, significantly reduced hospital and payer costs, as well as hospitalizations among patients with severe COPD.

The second study suggested that non-invasive ventilation, when used together with home oxygen therapy, can increase admission-free survival — the length of time a patient lives without being admitted to hospital.

“Many clinicians still reference dated information when considering COPD treatment methods, yet technologies, machines, and even masks have advanced significantly since PAP therapy was first introduced,” said Eli Diacopoulos, Philips Respiratory Care Business Leader.