Non-invasive ventilation

Non-invasive ventilation (NIV) is an external treatment used to help people with severe problems with breathing. It involves wearing a mask connected to a machine (ventilator) which makes breathing in and out easier. It supports the muscles in the lungs to work properly, especially during the night.

Why is it used?

Everyone breathes in oxygen from the air to stay alive. The oxygen goes into the bloodthrough the lungs. When the body has used the oxygen, it produces carbon dioxide which is breathed out. This is called ventilation. Some people with severe lung problems are unable to breathe in enough oxygen and breathe out carbon dioxide which can lead to the lungs not working properly.

Chronic Obstructive Pulmonary Disease:

Chronic Obstructive Pulmonary Disease (COPD) is the name for a group of lung conditions that cause breathing difficulties. It includes: emphysema (damage to the air sacs in the lungs) and chronic bronchitis (long-term inflammation of the airways). Symptoms may includeconstant breathlessness, constant chesty cough with phlegm, frequent chest infections and constant wheeze. The breathing problems tend to get gradually worse over time and can limitthe patient’s normal activities.

Causes of COPD

COPD happens when the lungs become inflamed, damaged and narrowed. The main cause of COPD is smoking. However, it can sometimes affect people who have never smoke, however have had long term exposure to harmful fumes or dust. Damage to the lungs caused by COPDis permanent; however, treatment may help to slow down the condition.


Treatments for COPD include:

  • Smoking cessation to help patient with COPD to stop smoking
  • Inhalers and medications
  • Programme of exercise and education
  • Surgery or a lung transplant.

COPD can result in patients being admitted to hospital and needing support to breathe through non-invasive ventilation.

Eligibility criteria:

Non-invasive ventilation for Chronic Obstructive Pulmonary Disease at home is restricted. To beconsidered the patient must have been reviewed by their specialist respiratory/ventilation teamto confirm they meet the following criteria:

  • The patient has a lowered lung capacity which has been measured by the specialist respiratory team


  • Blood tests show the patient is not breathing out enough carbon dioxide

The patient must also have ONE of the following:

  • A reduced quality of life identified by symptoms consistent with sleep disordered breathing problems e.g. extreme daytime sleepiness, headache, confusion, increased shortness of breath, resting tremor


  • More than one condition affecting the level of oxygen in the blood which could lead to high blood pressure in the lungs or heart failure


  • Two or more hospital admissions over the past 12 months needing non-invasiveventilation treatment during the admissions to which the patient has responded well.

This means the patient’s NHS commissioning organisation (CCG), who is responsible forbuying healthcare services on behalf of patients, will fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and the CCG supports this.

Neuro-muscular disorders:

Neuro-muscular disorders cause weakness of muscles which can lead to not being able to breathe properly. Patients with some of these conditions may need to use non-invasive ventilation (NIV) during the day and night to breathe more easily.

Patients with one of the following conditions who also meet the eligibility criteria below will be considered for non-invasive ventilation treatment at home:

Motor Neurone Disease

Motor neurone disease (MND) is a rare condition that affects the brain and nerves. It causes muscles and nerves to become weak which worsens over time.

Muscular Dystrophy

Muscular Dystrophy, including Duchenne Muscular Dystrophy gradually causes the muscles to weaken, leading to an increasing level of disability.

Multiple Sclerosis

Multiple sclerosis (MS) is a condition that can affect the brain and spinal cord, causing a wide range of potential symptoms including problems with vision, arm or leg movement, sensationor balance.

Post-polio syndrome

Polio is a viral infection which most people would have fought off without even knowing they had it. Post-polio syndrome is rarely life-threatening, however some people may develop breathing and swallowing difficulties.

Guillain-Barré syndrome

Guillain-Barré (pronounced ghee-yan bar-ray) syndrome is a very rare and serious condition that affects the nerves. It mainly affects the feet, hands and limbs, causing problems such as numbness, weakness and pain.


Syringomyelia is where a fluid-filled cavity called a ‘syrinx’ develops in the spinal cord. This candamage the spinal cord and cause muscular problems.

Tuberculosis (with respiratory impairment)

Tuberculosis (TB) is a bacterial infection which generally affects the lungs. If not treated it can cause the lungs to stop working properly.

Spinal Cord Injury

A spinal cord injury is where damage has been done to any part of the spinal cord or nervesat the end of the spine. It can cause the muscles that help you to breathe to stop working properly.

Other neuro muscular diseases which are known to cause muscle weakness and also affect breathing may be considered.

Eligibility criteria:

NIV for neuro muscular diseases at home is restricted. Patients with one of the neuromuscular conditions listed above must also meet the following criteria:

Ventilation at night

The patient must meet ONE of the following criteria:

  • Signs or symptoms of hypoventilation
  • Blood tests show the patient is not breathing in enough oxygen
  • Blood tests show the patient is not breathing out enough carbon dioxide.

Daytime ventilation

In addition to meeting the above criteria, the patient must also meet ONE of the following criteria:

  • Not being able to swallow properly due to shortness of breath, which is relieved byusing a ventilator
  • Unable to speak in full sentences due to breathlessness
  • Blood tests show the patient is not breathing in enough oxygen
  • Blood tests show the patient is not breathing out enough carbon dioxide
  • Symptoms of breathing difficulties whilst awake.

This means (for patients who DO NOT meet the above criteria) patient’s NHS commissioning organisation (CCG), who is responsible for buying healthcare services on behalf of patients, will only fund the treatment if an Individual Funding Request (IFR)application proves exceptional clinical need and the CCG supports this.

Advice and further guidance:

Treatment policy for patients covered by NHS Birmingham and Solihull CCG


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