Towards Personalised Care: Clinical Phenotyping and Outcomes in COPD Patients Receiving Home Mechanical Ventilation

Tidsperiod:

1 januari 2026 – 31 december 2028

Projektledare:

Andreas Palm

Finansiär:

Hjärt-Lungfonden

Bidragstyp:

Projektbidrag

Budget:

1 800 000 SEK

Bakgrund:

Home mechanical ventilation (HMV) in Chronic Obstructive Pulmonary Disease (COPD) is recommended for selected patients with persistent hypercapnic respiratory failure, based on randomised trials involving narrowly defined patient groups. However, real-world COPD patients often present with complex comorbidities and varying disease trajectories. Emerging evidence suggests that the benefit of HMV may differ substantially across clinical phenotypes, yet current guidelines do not account for this heterogeneity. Swedish data indicate that a majority of patients initiate HMV during an acute exacerbation, in contrast to guideline recommendations, which propose initiation electively.

Målsättning:

The overarching objective of this project is to improve treatment protocols and guidelines for the clinical management of patients with COPD on HMV. We will achieve this objective by evaluating HMV effectiveness in relation to clinical characteristics and disease stage. A central aim is to identify which patient populations experience the most significant therapeutic benefit from HMV and in which patient groups the treatment effect is more modest.

We hypothesise that resources for HMV are not optimally allocated due to the gap between clinical guidelines and real-world practice, as disease trajectory and response to HMV differ significantly across COPD phenotypes.

Arbetsplan:

This project uses data from the national DISCOVERY cohort, linking the Swedevox registry with several national health registries (e.g., National Patient Register, Prescribed Drug Register, Cause of Death Register, and Swedish Intensive Care Register). Using baseline data, we will identify COPD clusters and assess differences in survival, exacerbation, hospitalisation rates, including intensive care unit admissions across these clusters/clinical phenotypes.

Betydelse:

This project delivers a unique, and multi-faceted evaluation of COPD patients receiving home mechanical ventilation in real-world clinical practice. Through this integrated approach, we aim to define which patients benefit most from HMV, closing the critical gap between evidence from narrow clinical trials and the complexity of everyday COPD care. With my leadership in the national quality registry for respiratory failure, Swedevox, findings can be directly translated into updated guidelines.