INTRODUCTION: Chronic non-invasive ventilation (NIV) has become evidence-based 
care for stable hypercapnic COPD patients. While the number of patients 
increases, home initiation of NIV would greatly alleviate the healthcare burden. 
We hypothesise that home initiation of NIV with the use of telemedicine in 
stable hypercapnic COPD is non-inferior to in-hospital NIV initiation.
METHODS: Sixty-seven stable hypercapnic COPD patients were randomised to 
initiation of NIV in the hospital or at home using telemedicine. Primary outcome 
was daytime arterial carbon dioxide pressure (PaCO2) reduction after 6 months 
NIV, with a non-inferiority margin of 0.4 kPa. Secondary outcomes were 
health-related quality of life (HRQoL) and costs.
RESULTS: Home NIV initiation was non-inferior to in-hospital initiation 
(adjusted mean difference in PaCO2 change home vs in-hospital: 0.04 kPa (95% CI 
-0.31 to 0.38 kPa), with both groups showing a PaCO2 reduction at 6 months 
compared with baseline (home: from 7.3±0.9 to 6.4±0.8 kPa (p<0.001) and 
in-hospital: from 7.4±1.0 to 6.4±0.6 kPa (p<0.001)). In both groups, HRQoL 
improved without a difference in change between groups (Clinical COPD 
Questionnaire total score-adjusted mean difference 0.0 (95% CI -0.4 to 0.5)). 
Furthermore, home NIV initiation was significantly cheaper (home: median €3768 
(IQR €3546-€4163) vs in-hospital: median €8537 (IQR €7540-€9175); p<0.001).
DISCUSSION: This is the first study showing that home initiation of chronic NIV 
in stable hypercapnic COPD patients, with the use of telemedicine, is 
non-inferior to in-hospital initiation, safe and reduces costs by over 50%.
TRIAL REGISTRATION NUMBER: NCT02652559.