. 2022 Jun 2;11(11):3180. doi: 10.3390/jcm11113180

Table 2.

Clinical recommendations on the screening, assessment, and treatment of stable hypercapnic COPD.

Category	Recommendation
Screening	Patients with severe and very severe COPD and those on long-term oxygen therapy should have regular blood gas assessment.
Screening	Patients with acute hypercapnic respiratory failure should have a blood gas assessment at 2–4 weeks following discharge.
Assessment	Pharmacological and nonpharmacological COPD treatment and other disorders causing hypercapnia (i.e., obesity, neuromuscular, and chest wall diseases) should be evaluated during assessment.
Assessment	Routine sleep study should be offered to explore the presence of obstructive sleep apnoea and to identify variable (i.e., sleep-phase or positional) episodes of hypoventilation.
Treatment	Pharmacological therapy should be optimised to improve symptoms and reduce the number of exacerbations.
	Treatable traits contributing to hypercapnia (i.e., obesity and sarcopenia) should be addressed in parallel with NIV.
	Long-term NIV should be offered to those with persistent hypercapnic respiratory failure (PaCO₂ ≥ 52 mmHg (>6.8 kPa)).
	The effect of long-term NIV therapy should be assessed with routine blood gas tests, sleep studies, and COPD-related outcomes (i.e., symptoms, quality of life, and the number of exacerbations).
	NIV treatment should be titrated to normalise PaCO₂ (PaCO₂ < 52 mmHg (<6.8 kPa)).