Respiratory Support in Chronic Obstructive Pulmonary Disease (COPD) Patients

Prior treatment

• Patient treated with chronic NIV or continuous positive airway pressure (CPAP) device, with ongoing treatment;
• Sedative medication causing hypercapnia (\> 3 drugs or more than 20mg of morphine/day);

Other illness

• Primary diagnosis of restrictive lung disease causing hypercapnia i.e. obesity hypoventilation and chest wall disease, however these patients will be included if the "FEV1/Forced vital capacity (FVC)" ratio is \<60% and the FEV1 \<50% if the predominant defect is considered to be obstructive by the center clinician;
• Polygraphic diagnosis of Obstructive Sleep Apnoea Syndrome (AHI\>30/h (French criteria);
• Cognitive impairment that would prevent informed consent into the trial
• Psychiatric disease necessitating anti-psychotic medication, ongoing treatment for drug or alcohol addiction, persons of no fixed abode post-discharge;
• Unstable coronary artery syndrome;
• Expected survival\<12 months due to any situation other than COPD disease;

Age

• Age \<18 years;
• Measure of legal protection (guardianship, wardship or judicial protection) for patients over the age of majority.

Other

• BMI \> 35 kg/m2;
• Pregnancy;
• Tobacco use \< 10 pack-year;
• Inability to comply with the protocol;
• Duration of ICU stay\>10 days;
• No affiliated to national health insurance;

• 1\) Patients with COPD, GOLD C or D and Forced expiratory volume in one second (FEV1)\<65%;
• 2\) AHRF (pH\<7,35 and PaCO2≥45mm Hg (≥6kPa) treated more than 24h with Ventilation (non-invasive or invasive);
• 3\) 48h to 2 weeks with pH\>7.35, and PaCO2\>45 (\>6kPa) after NIV withdrawal, during daytime at rest without oxygen or ventilatory support (or with O2 if patients are not able to avoid O2 with immediate desaturation below 80%).