{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T22:13:50Z","timestamp":1779142430334,"version":"3.51.4"},"reference-count":28,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017647","name":"ResMed","doi-asserted-by":"publisher","award":["no grant number"],"award-info":[{"award-number":["no grant number"]}],"id":[{"id":"10.13039\/100017647","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2025,2,18]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Rationale<\/jats:title>\n                  <jats:p>Chronic obstructive pulmonary disease (COPD) is the most common indication for domiciliary non-invasive ventilation (NIV), but long-term outcomes data are limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This multistate model analysis estimated the impact of NIV therapy continuation versus cessation on transitions between three different disease states.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Model data came from the French national health insurance reimbursement system database for individuals aged \u226540 years with COPD and \u22651\u2009NIV reimbursement in 2015\u20132019.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Measurement and main results<\/jats:title>\n                  <jats:p>Data from 49\u2009503 patients started on NIV were included (median age 70 years, 51.2% male, median 1 exacerbation in the previous year). There were 80\u2009361 severe exacerbations and 18\u2009125 deaths (including 7805 in severe exacerbation). In multistate models, NIV continuation was associated with a significant reduction in transition to death, from severe exacerbation (HR 0.84, 95% CI 0.79 to 0.91) and without exacerbation (HR 0.88, 95%\u2009CI 0.83 to 0.93). NIV continuation versus cessation had no significant effect on transition between without exacerbation to severe exacerbation (HR 0.98, 95%\u2009CI 0.95 to 1.00) but was significantly associated with slower transition from severe exacerbation to without exacerbation (HR 0.87, 95%\u2009CI 0.84 to 0.89).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This multistate model analysis found that the long-term use of domiciliary NIV was associated with a lower risk of transitions to death, but was not associated with a reduction in recovery time after severe exacerbation. These data highlight the potential mortality benefits of long-term domiciliary NIV in COPD and can be used as one piece of evidence to support evidence-based guideline recommendations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/thorax-2024-222392","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T21:55:49Z","timestamp":1747864549000},"page":"616-623","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of long-term non-invasive ventilation on severe exacerbations and survival in COPD: a French nationwide cohort study using multistate models"],"prefix":"10.1136","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3832-2358","authenticated-orcid":false,"given":"Jean Louis","family":"P\u00e9pin","sequence":"first","affiliation":[{"name":"Universite Grenoble Alpes, Saint-Martin-d\u2019Heres, France"},{"name":"INSERM U1300, Laboratoire HP2, CHU Grenoble 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