The acute effects of noninvasive ventilatory support during exercise on exercise endurance and dyspnea in patients with chronic obstructive pulmonary disease: a systematic review.

PURPOSE The objective of this study was to review studies systematically, in which the acute effects of noninvasive ventilatory support (NIVS) during exercise were evaluated in patients with chronic obstructive pulmonary disease (COPD). In addition, a quantitative analysis was performed on the effects of NIVS on exertional dyspnea and exercise endurance. METHODS Literature was searched in electronic databases, and by scanning lists of references of studies and abstract books of annual congresses of the American Thoracic Society and European Respiratory Society. Preliminary data of a study by our own group into the effects of NIVS on exercise endurance in patients with COPD were added. The systematic review was carried out on the basis of a validated methodological screening list. For the quantitative analysis, Glass delta of individual studies were pooled to aggregate a summary effect size. RESULTS Fifteen studies were identified. Seven of these studies met the inclusion criteria, including a total of 65 patients with COPD. The methodological quality of the included studies varied from 31% to 54% of the maximum score of 13 points. Statistically significant summary effect sizes were found in the analysis of exertional dyspnea (P <.05) as well as in the analysis of exercise endurance (P <.001), indicating improvements in these outcomes in favor of NIVS. CONCLUSIONS The present systematic review suggests that NIVS during exercise may acutely reduce exertional dyspnea and improve exercise endurance, in patients with COPD.