Home non-invasive ventilation in patients with chronic obstructive pulmonary disease: a survey of current practice in Italy

Introduction: Optimal initiation and management of long-term home non-invasive ventilation (LTH-NIV) therapy requires a personalised approach that may not be possible within some healthcare systems. This survey of Italian physicians determined current practices regarding LTH-NIV initiation and follow-up in patients with chronic hypercapnic chronic obstructive pulmonary disease (COPD), areas for process improvements, and use of telemonitoring. Methods: A 35-question survey was developed then sent via e-mail for completion using computer-assisted web interviewing methodology. Respondents were Italian hospital-based physicians identified using a healthcare professional database who had 3 years' experience in pulmonology, treated/followed up at least 50 patients on NIV, and consented to participate. Results: 60/71 physicians approached completed the online survey. Of these, 41/60 (68%) said that LTH-NIV prescription followed hospitalisation for acute COPD exacerbation. The most important clinical aspects to monitor early after discharge and during long-term follow-up were reported as mask fit and patient quality of life. Physicians reported a high workload for management of patients on LTH-NIV, but felt that many therapy management tasks could be performed by other providers, especially outpatient pulmonologists and homecare providers. Only 32% of respondents were currently using telemonitoring; reasons for non-use were lack of human resources (63%) or regulatory framework (37%), and cost/reimbursement issues (22%). Conclusion: These data highlight substantial differences between LTH-NIV clinical practice for chronic hypercapnic COPD in Italy and current guidelines, suggesting that guideline-mandated processes may not be achievable or sustainable in real-world settings. Involvement of homecare providers and use of telemonitoring could help improve the management of LTH-NIV therapy.