The successful treatment of hypercapnic respiratory failure with oral modafinil

Figures & data

Table 1 Demographics of the six patients including spirometry and past medical history

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6
Age/sex (BMI kg/m^2)	87/M (23)	81/M (23)	68/M (30)	64/M (38)	78/F (18)	66/F (52)
Diagnosis (duration, years)	COPD (15)	COPD (12)	COPD (1.5)	COPD (6)	COPD (10)	PTH* (4)
Smoking status (pack-years)	4/d (70)	Ex-smoker 15 years (50)	30/d (60)	30/d (60)	Ex-smoker 3 years (50)	Passive
FEV1 (% predicted)	0.95 (41%)	0.69 (26%)	0.95 (37%)	1.12 (33%)	0.42 (24%)	0.73 (43%)
FVC (% predicted)	1.78 (55%)	1.84 (51%)	2.14 (54%)	2.76 (64%)	1.05 (45%)	1.1 (45%)
PEFR (% predicted)	253 (54%)	161 (36%)	188 (44%)	205 (40%)	100 (21%)	80 (26%)
PMH	AF HTN COPD	COPD OSA	COPD Aspirin allergy Polycythemia	COPD Polycythemia	TB Plombage 1950 Ca breast HTN Schizophrenia Anxiety Aortic stenosis	Gross obesity CCF PTH COPD
Chest X-ray	COPD	COPD	COPD	COPD	COPD, LUL plombage, pleural calcification	Cardiomegaly and dilated pulmonary arteries*

Note:

* Pulmonary hypertension.

Abbreviations: AF, atrial fibrillation; BMI, body mass index; Ca breast, breast cancer; CCF, congestive cardiac failure; COPD, chronic obstructive pulmonary disease; d, day; F, female; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; HTN, hypertension; LUL, left upper lobe; M, male; OSA, obstructive sleep apnea; PEFR, peak expiratory flow rate; PMH, past medical history; PTH, pulmonary hypertension; TB, tuberculosis.

Table 2 Measures of hypercapnic respiratory failure and response to modafinil after 10 days

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6
Admission arterial gases (on air)*
pH	7.32	7.33	7.33	7.45	7.22	7.35
PaO2	6.88	8.61	5.7	5.8	5.46	5.4
PaCO2	8.24	8.08	8.84	6.76	14.2	8.6
Daytime mean (air) saturations	80%	75%	80%	80%	67%	89%
Nocturnal mean (air) saturations	No data	65%	77%	66%	72%	75%
NIPPV settings IPAP (EPAP)	10 (6)	20 (8)	Rejected	Rejected	12 (6)	16 (8)
After 10 days of modafinil
Daytime mean (air) saturations	91%	94%	92%	92%	93%	90%
Nocturnal mean (air) saturations	87%	90%	85%	76%	87%	81%
Gases on air* after 10 days
pH	7.44	7.61	7.42	7.41	7.48	7.45
PaO2	9.7	8.5	8.5	8.6	9.1	7.5
PaCO2	5.86	6.1	6.41	6.21	6.59	6.9
AHI	28	2.6	69	31	8	83
Duration without further HRF, months	15	15	21	36	10	17
Readmissions in HRF	No	No	No	Yes with exacerbation after 36 months	Yes at death after 60% oxygen	No
Cause of death	Pneumonia	Alive	Alive	Alive	Pneumonia	Alive

Note:

* kPa.

Abbreviations: AHI, apnea–hypopnea index; EPAP, expiratory positive airway pressure; HRF, hypercapnic respiratory failure; IPAP, inspiratory positive airway pressure; NIPPV, nasal intermittent positive pressure ventilation; PaO₂, partial pressure of arterial oxygen; PaCO₂, partial pressure of arterial carbon dioxide.