Laryngeal observations during non-invasive ventilation titration in chronic obstructive pulmonary disease

<bold>Background:</bold> High-pressure non-invasive ventilation (NIV) is used in chronic obstructive pulmonary disease (COPD) to normalize hypercapnia, thereby enhancing quality of life and improving survival. Despite the benefits, treatment adherence poses challenges. We hypothesized that adverse upper airway responses during NIV may influence treatment efficacy and patient outcomes. <bold>Aims:</bold> To visualise and describe the laryngeal responses to NIV in individuals with COPD. <bold>Methods:</bold> An explorative observational study including awake individuals with stable hypercapnic COPD. Laryngeal responses were examined with video-recorded transnasal fiberoptic laryngoscopy during NIV treatment, using a predefined titration protocol starting from each participant’s individual settings up to the inspiratory pressure (IPAP) limit of the patients’ device (25 or 30 cmH2O). The laryngeal responses during NIV were assessed from video-recordings. <bold>Results:</bold> Eight participants with COPD were included, baseline IPAP levels ranging from 12-26 cmH2O. Among participants where the device’s upper IPAP limit was 25 cmH2O (n=4; baseline IPAP 12-22), 3/4 had normal laryngeal responses. In participants using a device with an upper limit of 30 cmH2O (n=4; baseline IPAP 14-26) laryngeal adduction was observed at high pressures in all. <bold>Conclusion:</bold> Laryngeal responses to NIV in hypercapnic stable COPD were heterogeneous, with a tendency for increased IPAP to induce laryngeal adduction. Further studies are warranted, using NIV devices capable of delivering higher pressures, to ascertain whether laryngeal obstruction occurs exclusively at pressures exceeding 25 cmH2O.