Impact of high-flow oxygen therapy during exercise in idiopathic pulmonary fibrosis: a pilot crossover clinical trial

Abstract

Background Supplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Although high-flow nasal cannula oxygen therapy (HFNC) improves oxygenation in other respiratory diseases, its impact on exercise performance has never been evaluated in IPF patients. We hypothesized that HFNC may improve exercise capacity in IPF subjects compared to SOT. Methods This was a prospective, crossover, pilot randomized trial that compared both oxygenation methods during a constant submaximal cardiopulmonary exercise test (CPET) in IPF patients with exertional oxygen saturation (SpO2) ≤ 85% in the 6-min walking test. The primary outcome was endurance time (Tlim). Secondary outcomes were muscle oxygen saturation (StO2) and respiratory and leg symptoms. Results Ten IPF patients [71.7 (6) years old, 90% males] were included. FVC and DLCO were 58 ± 11% and 31 ± 13% pred. respectively. Tlim during CPET was significantly greater using HFNC compared to SOT [494 ± 173 vs. 381 ± 137 s, p = 0.01]. HFNC also associated with a higher increase in inspiratory capacity (IC) [19.4 ± 14.2 vs. 7.1 ± 8.9%, respectively; p = 0.04], and a similar trend was observed in StO2 during exercise. No differences were found in respiratory or leg symptoms between the two oxygen devices. Conclusions This is the first study demonstrating that HFNC oxygen therapy improves exercise tolerance better than SOT in IPF patients with exertional desaturation. This might be explained by changes in ventilatory mechanics and muscle oxygenation. Further and larger studies are needed to confirm the benefits of HFNC in IPF patients and its potential usefulness in rehabilitation programs.

Enhancing exercise tolerance in interstitial lung disease with high‐flow nasal cannula oxygen therapy: A randomized crossover trial

“…Most studies on exercise in patients with ILD compared the effects of HFNC therapy with those of standard‐ or Venturi‐mask oxygen therapy 11–14 . However, these studies did not clarify the effects of oxygen and gas flow rates on exercise tolerance.…”

“…In contrast, HFNC therapy improved endurance time, minimum percutaneous oxygen saturation (SpO 2 ), and leg effort at iso‐time in patients with stable idiopathic pulmonary fibrosis (IPF). Subsequent reports confirmed that HFNC therapy prolongs endurance time 12–14 …”

IPF Respiratory Symptoms Management — Current Evidence

“…Three-day survival and in-hospital mortality did not differ significantly between the groups ( 39 ). Furthermore, HFNC compared to standard oxygen therapy seems to improve endurance time of IPF patients during constant-load exercise testing on cycloergometer in laboratory studies ( 40 – 42 ).…”

Is it time to use HFNC oxygen therapy during exercise in IPF patients?

“…In this study, HFNC oxygen therapy significantly improved endurance time compared to controls (647.5 vs. 577 s, p = 0.0018). Previously, Badenes-Bonet et al 4 enrolled 10 IPF patients with more severe disease (FVC 58% predicted, DL CO 31% predicted, minimum oxygen saturation [SpO 2 ] % during 6-min walking test [6MWT] 76%) using a variable fraction of inspired oxygen (FiO 2 ) and HFNC setting. Endurance time during cardiopulmonary exercise testing (CPET) was significantly greater using HFNC compared to Venturi mask (VM) oxygen therapy (494 vs. 381 s, p = 0.01).…”