Ventilation Options for COPD

Topic Overview

Mechanical ventilation means having a machine help you breathe. If you have COPD, you may need this treatment when your breathing problems suddenly get worse and stay worse. These breathing attacks are called COPD exacerbations or flare-ups.

This treatment is usually used until you are able to breathe better. In rare cases, it is used as long-term therapy in your home or a care facility.

There are two kinds of ventilation:

• Noninvasive: Nothing is inserted into your mouth or throat.
• Invasive: A breathing tube is inserted into your throat.

Noninvasive ventilation

The full name for this is noninvasive positive-pressure ventilation, sometimes shortened to NPPV. A machine pushes air into your lungs through a mask that covers your nose or your nose and mouth.

This treatment generally is recommended when you're having a very hard time breathing because of a COPD attack and sudden lung failure.^{footnote 1, footnote 2}

Studies show that this treatment:^{footnote 1, footnote 2}

• Can shorten hospital stays.
• Helps more people survive in the hospital.
• Makes it less likely that you will need a tube inserted into your windpipe.

But studies also show that people with only mild COPD attacks aren't helped by this treatment.^{footnote 1}

It's not clear whether this treatment helps people with severe stable COPD. Studies have shown conflicting results. Some research shows a possible positive benefit. Other research shows no benefit.^{footnote 3} More study needs to be done.

People who have very low blood pressure, are not breathing on their own, and are not fully able to think and interact with caregivers are not considered good candidates for this treatment. For them, invasive mechanical ventilation is considered safer.

Invasive ventilation

In invasive mechanical ventilation, a breathing tube is inserted into your windpipe, and a machine forces air into your lungs.

Although this can save your life during a COPD attack, it doesn't always help. Consider talking with your doctor and your family ahead of time about what kind of treatment you want.

Consider that:

• You will probably need pain medicine and a sedative to calm you. You may occasionally need drugs to paralyze the respiratory muscles so that the machine can do its work.
• The medicines make it hard for you to communicate with caregivers. And they can have harmful effects on your blood pressure and bowel function.
• The treatment can make you more likely to have a collapsed lung, in which there is air in the chest that is outside of the lung.
• You have a higher risk of a type of pneumonia called ventilator-associated pneumonia. The breathing tube may interfere with how your body works to prevent pneumonia. This type of pneumonia is more likely to be caused by bacteria that are resistant to antibiotics. That makes it hard to treat. There is less risk of getting this pneumonia with noninvasive ventilation.
• Although it's rare, breathing tubes can harm the vocal cords or the windpipe.