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Mediators of Inflammation
Volume 2014 (2014), Article ID 503145, 11 pages
http://dx.doi.org/10.1155/2014/503145
Research Article

Long-Term Home Noninvasive Mechanical Ventilation Increases Systemic Inflammatory Response in Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

1Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
2Department of Respiratory Diseases, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy
3Department of Respiratory Diseases, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy
4Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy
5IRCCS Fondazione Don Carlo Gnocchi-Onlus, Via Maresciallo Caviglia 30, 00194 Rome, Italy
6Department of Anesthesia and Intensive Care Medicine, S. Giovanni Battista Molinette Hospital, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
7Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Via Atinense 18, Pozzilli, 86077 Isernia, Italy

Received 11 March 2014; Revised 8 May 2014; Accepted 11 May 2014; Published 25 May 2014

Academic Editor: Vittorio Fineschi

Copyright © 2014 Gregorino Paone et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Long-term home noninvasive mechanical ventilation (NIV) is beneficial in COPD but its impact on inflammation is unknown. We assessed the hypothesis that NIV modulates systemic and pulmonary inflammatory biomarkers in stable COPD. Methods. Among 610 patients referred for NIV, we shortlisted those undergoing NIV versus oxygen therapy alone, excluding subjects with comorbidities or non-COPD conditions. Sputum and blood samples were collected after 3 months of clinical stability and analyzed for levels of human neutrophil peptides (HNP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-alpha). Patients underwent a two-year follow-up. Unadjusted, propensity-matched, and pH-stratified analyses were performed. Results. Ninety-three patients were included (48 NIV, 45 oxygen), with analogous baseline features. Sputum analysis showed similar HNP, IL-6, IL-10, and TNF-alpha levels (). Conversely, NIV group exhibited higher HNP and IL-6 systemic levels () and lower IL-10 concentrations (). Subjects undergoing NIV had a significant reduction of rehospitalizations during follow-up compared to oxygen group (). These findings were confirmed after propensity matching and pH stratification. Conclusions. These findings challenge prior paradigms based on the assumption that pulmonary inflammation is per se detrimental. NIV beneficial impact on lung mechanics may overcome the potential unfavorable effects of an increased inflammatory state.