inquiry objectives: To describe a 7-year follow-up (1992 to 2000) of patients who were treated at home nasal positive-pressure ventilation (NPPV) for chronic hypercapnic respiratory failure.

Design: Prospective descriptive study

Setting: brace university hospitals and a pulmonary rehabilitation center

Patients: pair hundred eleven patients with obstructive pulmonary disorders (58 patients) or restrictive pulmonary disorders (post-tuberculosis, 23 patients; neuromuscular diseases [NM] 28 patients; post-poliomyelitis syndrome 12 patients; kyphoscoliosis [KYPH] 19 patients; obesity-hypoventilation syndrome [OHS] 71 patients) who were treated on long-term NPPV.

Intervention: Annual, elective, standardized medical evaluations.

Measurements: Pulmonary function proofs arterial blood gas levels, health status, compliance, survival and probability of pursuing NPPV and hospitalization rates.

Results: Patients with OH NM and KYPH had the highest probability of pursuing NPPV while patients with COPD had the lowest values. Overall, the compliance rate was high (noncompliance rate, 15%) As of 1994 COPD and OH became the greatest in number frequent indications for NPPV, increasing regularly, while other indications remained stable. The use of pressure-cycl ventilators progressively replaced that of volume-cycl ventilators in in the greatest degree indications. Hospitalization rates decreased in all clumps after initiating NPPV, when compared with the year before NPPV for up to 2 years in COPD patients, and 5 years in non-COPD patients.

Conclusion: Major changes in patient selection for NPPV occurr during the inquiry period with a marked increase in COPD and OH The shift toward les expensive pressure-cycl ventilators and the decrease in hospitalizations after initiating NPPV have had positive impacts forward the cost-effectiveness of NPPV in patients with chronic respiratory failure.

guide words: COPD; intermittent positive-pressure ventilation; noninvasive positive-pressure ventilation; obesity-hypoventilation syndrome

Abbreviations: ABG = arterial family gas; ANTADIR = National Association for domestic circle Care of Patients with Chronic Respiratory Insufficiency; BMI = body-mass index; CPAP = continuous positive airway pressure; HAD = hospital anxiety and depression; HMV = place of abode mechanical ventilation; KYPH = kyphoseoliosis; LTOT = long-term oxygen therapy; NM = neuromuscular; NPPV = nasal positive-pressure ventilation; OH = obesity-hypoventilation syndrome; OSAS = obstructive repose apnea syndrome; PEmax = maximal inlet expiratory pressure; PImax = maximal cavity between the jaws inspiratory pressure; POLIO = post-polio syndrome; PPV = positive-pressure ventilation; PRC = pulmonary rehabilitation center; QOL = quality of life; Sa[O.sub.2] = arterial oxygen saturation; TB = tuberculosis

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Until the early 1980 long-term positive-pressure ventilation (PPV) was delivered either invasively, by means of tracheostomy, or, although rarely in Western Europe at mouth. (1) The first reports of nasal PPV (NPPV) were those of Rideau (2) and Delaubier et al, (3) who described the happy management of two patients with Duchenne muscular dystrophy at NPPV over a 2-year period. As of 1987 several clumps had reported (4-9) on the prosperous use of NPPV in patients with chronic respiratory failure related to neuromuscular (NM) diseases, chest wall diseases, or post-poliomyelitis syndrome (POLIO). Thereafter, the increase in the number of patients treated through NPPV was spectacular. In France, the number of patients receiving NPPV treated by the agency of the National Association for place of abode Care of Patients With Chronic Respiratory Insufficiency (ANTADIR) increased from 130 in 1988 to 3120 in 1998 (10) The first reports of NPPV in Switzerland were published in 1989 (11) At the conclusion of 1989, nationwide, 46 patients were receiving family mechanical ventilation (HMV; 30% used NPPV) At not away 500 patients are receiving NPPV in Switzerland, with 155 being treated in the Geneva Lake area (ie, a prevalence of 15 for [10.sup.5] inhabitants). (12)

sum of two units major changes have occurred in HMV during the past 10 years. The first is that of patient selection, with a marked increase in long-term ventilation therapy for patients with COPD and obesity-hypoventilation syndrome (OHS) (13-16) The inferior change is that of the equipment used for domicile NPPV. Bilevel pressure-cycled ventilation, which was introduced in the early 1990 (1718) has been increasingly used above the past 8 years, mainly because of lower prices than volume-cycled ventilation, lighter weight of the equipment, in many cases improved patient comfort, and simplicity of use. Several retrospective reports (819-23) have shown the feasibility of long-term domiciliary NPPV in patients with restrictive and obstructive respiratory disorders. However, either all or greatest in number patients in these studies were treated with volume-cycl ventilators. No long-term data are at the same time available for patients treated with pressure-cycl ventilators. The at hand study describes the changes that occurr throughout a 7-year observation period (1992 to 2000) in a cohort of patients treated at home NPPV in the Geneva Lake area. We shall emphasize the changes in the equipment used for NPPV (with their impact forward the correction of hypercapnia, the probability of pursuing NPPV and survival) and the changes in patient selection. The impact of NPPV in succession the use of health resources (ie, hospitalizations) in restrictive or obstructive lung disorders also will be discussed.

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