• Sandra Søgaard Tøttenborg, Søren Paaske Johnsen, Reimar Wernich Thomsen, Henrik Nielsen, Ejvind Frausing Hansen, and Peter Lange.
• Department of Public Health, Section of Social Medicine, University of Copenhagen, 1014 Copenhagen, Denmark.
• Dan Med J. 2013 Aug 1;60(8):A4686.

IntroductionA nationwide chronic obstructive pulmonary disease (COPD) quality improvement programme--DrCOPD--was initiated in Denmark in 2008. We examined subsequent national and regional trends in the use of non-invasive ventilation (NIV) and trends in mortality following NIV and invasive mechanical ventilation among patients acutely admitted with a COPD exacerbation.Material And MethodsWe did a nationwide, population-based prospective study using DrCOPD to identify all incident hospitalizations with COPD from 2008 through 2011 (n = 24,982) and to record the use of NIV during hospitalization. Date of death was retrieved from the Danish Civil Registration System.ResultsDuring follow-up, the use of NIV treatment in patients with first-time COPD hospitalization increased statistically significantly in all five Danish regions. At the national level, the use of NIV increased from 5.8% to 7.0% (adjusted for age, sex and co-morbidity, relative risk (RR): 1.21, 95% confidence interval (CI): 1.05-1.38). Concurrently, a statistically significant increase from 1.3% to 1.8% (RR: 1.36; 95% CI: 1.03-1.80) in NIV given together with invasive mechanical ventilation was observed. During the four years of follow-up, mortality remained stable with some regional variation. In-hospital mortality following NIV was also stable over time, while mortality decreased slightly in patients treated with both NIV and invasive mechanical ventilation.ConclusionUse of NIV in Denmark increased after the launch of a national COPD quality programme in 2008. However, regional variation remains and no substantial improvements in mortality have been observed. Continued efforts are warranted to ensure appropriate implementation of NIV.FundingThe study was supported financially by University of Copenhagen and the Danish Lung Association.Trial RegistrationThe study was approved by the Danish Data Protection Agency (record no. 2012-41-0438), the Danish National Indicator Project, Danish Regions and the Danish Ministry of Health.

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