A systematic review found that approximately 86% of COPD patients newly prescribed noninvasive positive airway pressure therapy successfully accept and use the treatment, with an average daily use of 6.3 hours.
- 14% of COPD patients decline or discontinue PAP therapy, usually within 6 weeks
- Successful users average 6.3 hours of therapy per day
- Acceptance rates are higher for sleep apnoea than chronic respiratory failure
How this compares to prior research
PAP therapy has been established as an effective treatment for obstructive sleep apnoea and chronic respiratory failure in COPD patients. However, previous research has primarily focused on clinical outcomes rather than systematically examining how many patients actually accept and continue using the therapy. This review addresses that gap by pooling data across multiple studies to provide the first comprehensive picture of real-world PAP uptake and adherence patterns in the COPD population.
COPD prevalence among global population, 1980–1989
Key findings
- PAP therapy was declined or discontinued by 14% of COPD patients on average, with most discontinuations occurring within 6 weeks of starting treatment
- Among patients who continued therapy, the pooled median adherence was 6.3 hours per day
- Patients using PAP for obstructive sleep apnoea showed higher acceptance rates but shorter daily use compared to those with chronic hypercapnic respiratory failure
What this means in practice
- Ask your doctor about early support programs if starting PAP therapy, as most discontinuations happen within 6 weeks
- Expect to use the device for about 6 hours daily if you continue with treatment
- Discuss your specific condition with your healthcare provider, as acceptance rates differ between sleep apnoea and respiratory failure
Frequently asked questions
What is PAP therapy for COPD patients?
PAP (positive airway pressure) therapy is a noninvasive treatment that uses a machine to deliver pressurised air through a mask, helping COPD patients breathe more easily, especially those with sleep apnoea or respiratory failure.
How long do COPD patients typically use PAP therapy each day?
Patients who successfully use PAP therapy average 6.3 hours per day, though this varies depending on whether they\’re treating sleep apnoea or chronic respiratory failure.
When do most COPD patients stop using PAP therapy?
Among those who discontinue treatment, most do so within the first 6 weeks of starting PAP therapy, highlighting the importance of early support and monitoring.
Key terms explained
Noninvasive positive airway pressure (PAP)
A breathing treatment that uses a mask to deliver pressurised air into the lungs without requiring surgery or tubes inserted into the airway
Chronic hypercapnic respiratory failure (CHRF)
A condition where the lungs cannot remove enough carbon dioxide from the blood, leading to dangerously high CO2 levels
Obstructive sleep apnoea (OSA)
A sleep disorder where breathing repeatedly stops and starts due to airway blockage during sleep
Source: Implementation of long-term noninvasive positive airway pressure therapy in patients with COPD: a systematic review and meta-analysis of acceptance and adherence. · DOI: doi: 10.1183/16000617.0231-2025
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