A 20 year experience of home non-invasive ventilation (NIV) in a district general hospital and the “growing” problem of obesity

Most non-invasive ventilation services in the UK are tertiary centre based and cover many hospitals with variable referral practices. This study is from one hospital serving a population of 330,000 and therefore provides data of utilisation per 100,000 of population and changes over time. Methods: A study was done on 191 patients who were started on home NIV between 1990 and 2010. There was complete data for 171 patients and these are included. Results: The range of conditions, age, FEV1, FVC and survival are shown in the table below; The 2 year survival from Kaplan-Meier curves was 55% for bronchiectasis, 45% for COPD, 80% for thoracic cage, 35% for neuromuscular, 85% for OHS and 75% for overlap syndrome. The current NIV prevalence per 100,000 for each condition was 1.8 for bronchiectasis, 7.3 for COPD, 2.4 for thoracic cage abnormalities, 4.2 for neuromuscular disease, 8.2 for OHS and 6.7 for overlap syndrome. 59% of patients ventilated over the last 5 years had obesity hypoventilation or overlap syndrome, compared to only 12% in the previous 15 years. Conclusion: OHS and overlap syndrome have rapidly increased as indications for home NIV. The survival of these groups appears to be long. These factors will have profound implications for the future planning of home NIV services.