Home High-Flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD: A Randomized Clinical Trial

Abstract

Rationale The long-term effects of using a high-flow nasal cannula for chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease remain unclear. Objectives To assess whether long-term high-flow nasal cannula use reduces the number of exacerbations and improves other physiological parameters in patients with chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease. Methods We enrolled 104 participants (aged ⩾40 yr) with daytime hypercapnia (Global Initiative for Chronic Obstructive Lung Disease stages 2–4) receiving long-term oxygen therapy (⩾16 h/d for ⩾1 mo) and randomly assigned them to high-flow nasal cannula/long-term oxygen therapy and long-term oxygen therapy groups. The primary endpoint was the moderate or severe exacerbation rate. We compared changes from baseline in arterial blood gas values, peripheral oxygen saturation, pulmonary function, health-related quality-of-life scores, and the 6-minute-walk test. Measurements and Main Results High-flow nasal cannula use significantly reduced the rate of moderate/severe exacerbations (unadjusted mean count 1.0 vs. 2.5, a ratio of the adjusted mean count between groups [95% confidence interval] of 2.85 [1.48–5.47]) and prolonged the duration without moderate or severe exacerbations. The median time to first moderate or severe exacerbation in the long-term oxygen therapy group was 25 (14.1–47.4) weeks; this was not reached in the high-flow nasal cannula/long-term oxygen therapy group. High-flow nasal cannula use significantly improved health-related quality of life scores, peripheral oxygen saturation, and specific pulmonary function parameters. No safety concerns were identified. Conclusions A high-flow nasal cannula is a reasonable therapeutic option for patients with stable hypercapnic chronic obstructive pulmonary disease and a history of exacerbations. Clinical trial registered with www.umin/ac.jp (UMIN000028581) and www.clinicaltrials.gov (NCT03282019).

High-flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD: Just Good Enough?

“…The inconsistency reminds us that there leaves much to be elucidated before introducing HFNC to home use for patients with COPD with hypercapnia. The least amount of time patients should spend on HFNC each day to guarantee a therapeutic effect needs to be investigated, as the current studies reported a wide range from 1.6 hours per day to 7.3 hours per day ( 1 , 2 , 4 ). The flow rate of HFNC needs to be titrated both during sleep and daytime.…”

“…The least amount of time patients should spend on HFNC each day to guarantee a therapeutic effect needs to be investigated, as the current studies reported a wide range from 1.6 hours per day to 7.3 hours per day ( 1 , 2 , 4 ).…”

“…In this issue of the Journal , Nagata and colleagues (pp. 1326–1335 ) brought us new insights into long-term home HFNC oxygen therapy (HFNC/LTOT) for patients with COPD with chronic hypercapnic respiratory failure ( 4 ). They found that HFNC/LTOT could reduce the frequency of moderate or severe COPD exacerbations.…”

“…As the first randomized controlled trial of HFNC/LTOT on patients with stable COPD with chronic hypercapnic respiratory failure, the effectiveness of long-term HFNC on hypercapnia should be the main concern. Nagata and colleagues found only a transient improvement of Pa CO 2 (at 12 wk) ( 4 ). We noticed that another study found that 12-month use of HFNC could stabilize the concentration of CO 2 in patients with COPD with persistent hypoxic and hypercapnic failures ( 3 ).…”

High Flow Nasal Oxygen at Home to Prevent Chronic Obstructive Pulmonary Disease Exacerbations?

“…In the current issue of the Journal , Nagata and colleagues ( 14 ) (pp. 1326–1335) assessed the effects of long-term HFNC at home in hypercapnic patients treated with long-term oxygen therapy (at least 16 h/d) for moderate-to-severe COPD.…”