The effectiveness of non-invasive positive pressure ventilation combined with rehabilitation training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND

Pulmonary rehabilitation (PR) is a cornerstone of chronic obstructive pulmonary disease (COPD) management, but exercise intolerance often limits its effectiveness. Non-invasive positive pressure ventilation (NPPV) during PR may enhance training tolerance and outcomes, yet the overall evidence remains uncertain.

OBJECTIVES

To evaluate the effects of adding NPPV to PR on exercise capacity, dyspnea, and respiratory muscle strength in patients with COPD.

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs).

DATA SOURCES AND

METHODS

We searched PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL from inception to December 2024 for RCTs evaluating NPPV combined with PR in patients with COPD. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias Assessment Tool for Randomized Trials (RoB 2), extracted data, and performed analyses using RevMan 5.3.

RESULTS

A total of 17 RCTs (489 participants; predominantly GOLD stage III-IV) were included. NPPV + PR significantly improved 6-minute walk distance (MD = 29.1 m, 95% CI: 3.6-54.6), incremental shuttle walk test distance (MD = 21.8 m, 95% CI: 5.0-38.7), peak oxygen uptake (SMD = 0.53, 95% CI: 0.23-0.83), maximal inspiratory pressure (Pimax; MD = 5.8 cmH2O, 95% CI: 1.0-10.7), and maximal expiratory pressure (Pemax; MD = 14.9 cmH2O, 95% CI:4.1-25.7). Significant reductions were observed in blood lactate levels (MD = -0.49 mmol/L, 95% CI:-0.79 to -0.19), BORG dyspnea score (MD = -1.1, 95% CI: -1.7 to -0.6), and mMRC scale (MD = -0.3, 95% CI: -0.5 to -0.1). No significant effect was found on quality of life.

CONCLUSION

Adding NPPV to exercise-based PR provides clinically meaningful improvements in exercise capacity, dyspnea, and respiratory muscle strength in patients with COPD who have significant exercise limitation. NPPV may be a valuable adjunct to optimize PR outcomes in this population.

TRIAL REGISTRATION: This review was prospectively registered in PROSPERO (CRD42023486598).