Non-invasive ventilation in the management of bronchiectasis

<bold>Introduction:</bold> Patients with bronchiectasis can develop hypercapnic ventilatory failure in the later stages of their disease. The role of non-invasive positive pressure ventilation (NIV) in this context is unclear. There are benefits of domiciliary NIV on mortality and hospital admission in ventilatory failure due to chronic obstructive pulmonary disease (COPD). There is some evidence to suggest patients with COPD and non-CF bronchiectasis can have improvements in pCO₂, exacerbation frequency and number of hospital admissions. We aimed to assess the benefit of NIV in hypercapnic respiratory failure in patients with bronchiectasis in a single centre cohort. <bold>Methods:</bold> A retrospective review of 42 patients with bronchiectasis as primary or secondary diagnoses initiated on domiciliary NIV took place. Data was collected on lung function, admissions, antibiotic use and respiratory microbiology, pre and post NIV. <bold>Results:</bold> Average age was 68 yrs, 52% males, 67% current or ex-smokers. Over a 6 year period, 8 (19%) patients had a reduction in the number of admissions to hospital after starting NIV. Seven had objective evidence of COPD, with an average FEV1 of 0.88. There was an overall 11% reduction in bacterial cultures following commencement of NIV (Haemophilus 26% reduction and Pneumococcus 9%). <bold>Conclusions:</bold> NIV may be useful in non-CF bronchiectasis to help with sputum clearance. This is likely to be most useful in patients with the severe airways disease and compromised respiratory muscle function as this usually results in chronic respiratory infection with reduced sputum clearance. A larger multi-centre cohort of predominantly bronchiectasis patients would allow further exploration.