• Clancy J Dennis, Collette Menadue, Tessa Schneeberger, Daniela Leitl, Ursula Schoenheit-Kenn, Camilla M Hoyos, Alison R Harmer, David J Barnes, Andreas R Koczulla, Klaus Kenn, and Jennifer A Alison.
• Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Electronic address: cden2754@uni.sydney.edu.au.
• Chest. 2021 Dec 1; 160 (6): 2066-2079.

BackgroundDuring exercise, dynamic hyperinflation (DH), measured by a reduction in inspiratory capacity (IC), increases exertional dyspnea and reduces functional capacity in many patients with severe COPD. Although noninvasive ventilation (NIV) during exercise can improve exercise duration, the effect on DH is unclear.Research QuestionsIn people with COPD, resting hyperinflation, and evidence of DH during exercise, does bilevel NIV during exercise reduce DH and increase endurance time compared with exercise with no NIV, and does NIV with an individually titrated expiratory positive airway pressure (T-EPAP) reduce DH and increase exercise endurance time more than NIV with standardized EPAP (S-EPAP) of 5 cm H2O?Study Design And MethodsA randomized crossover trial in which investigators and participants were blinded between NIV interventions was performed. Participants (N = 19; FEV1 of 1.02 ± 0.24 L (39% ± 6% predicted) completed three constant work rate endurance cycle tests in random order-no NIV, NIV with S-EPAP, and NIV with T-EPAP-during exercise. Primary outcomes were isotime IC and exercise endurance time. Outcome measures from each intervention were compared at isotime and at end exercise by using a linear mixed-model analysis.ResultsCompared with no NIV, isotime IC and endurance time were greater with both NIV with S-EPAP (mean difference: 95% CI, 0.19 L [0.10-0.28]; 95% CI, 153 s [24-280], respectively) and T-EPAP (95% CI, 0.22 L [0.13-0.32]; 95% CI, 145 s [28-259], respectively). There was no difference between NIV with S-EPAP and NIV with T-EPAP.InterpretationIn people with COPD and DH during exercise, NIV during exercise reduced DH and increased cycle endurance time. An S-EPAP of 5 cm H2O was adequate to obtain these benefits.Trial RegistryAustralian New Zealand Clinical Trials Registry; No.: ACTRN12613000804785; URL: http://www.anzctr.org.au.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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