Thirty patients were selected with severe and very severe COPD(GOLD 3 and GOLD 4) with Forced expiratory volume in 1stsecond/Forced vital capacity (FEV1/FVC) <70% and FEV1<50% predicted [20], associated with day time hypercapnia(PaCO2 P50 mmHg) and stable clinical condition (no exacerbation for the prior four weeks with (pH P 7.35) [21], receivingproper medications according to GOLD 2011 [20].
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