Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure

Abstract

BackgroundThis study investigated the long-term effects of humidified high-flow nasal cannula (HFNC) in COPD patients with chronic hypoxemic respiratory failure treated with long-term oxygen therapy (LTOT).Patients and methodsA total of 200 patients were randomized into usual care ± HFNC. At inclusion, acute exacerbation of COPD (AECOPD) and hospital admissions 1 year before inclusion, modified Medical Research Council (mMRC) score, St George’s Respiratory Questionnaire (SGRQ), forced expiratory volume in 1 second (FEV1), 6-minute walk test (6MWT) and arterial carbon dioxide (PaCO2) were recorded. Patients completed phone interviews at 1, 3 and 9 months assessing mMRC score and AECOPD since the last contact. At on-site visits (6 and 12 months), mMRC, number of AECOPD since last contact and SGRQ were registered and FEV1, FEV1%, PaCO2 and, at 12 months, 6MWT were reassessed. Hospital admissions during the study period were obtained from hospital records. Hours of the use of HFNC were retrieved from the high-flow device.ResultsThe average daily use of HFNC was 6 hours/day. The HFNC group had a lower AECOPD rate (3.12 versus 4.95/patient/year, p<0.001). Modeled hospital admission rates were 0.79 versus 1.39/patient/year for 12- versus 1-month use of HFNC, respectively (p<0.001). The HFNC group had improved mMRC scores from 3 months onward (p<0.001) and improved SGRQ at 6 and 12 months (p=0.002, p=0.033) and PaCO2 (p=0.005) and 6MWT (p=0.005) at 12 months. There was no difference in all-cause mortality.ConclusionHFNC treatment reduced AECOPD, hospital admissions and symptoms in COPD patients with hypoxic failure.

Nasal high‐flow therapy compared with non‐invasive ventilation in COPD patients with chronic respiratory failure: A randomized controlled cross‐over trial

“…There are limited data over a longer time frame but two studies have examined the addition of NHF to long‐term oxygen therapy (LTOT) . Nagata et al recruited 32 people with COPD and hypercapnic respiratory failure.…”

“…NHF at a mean flow of around 30 L/min lowered PaCO 2 by 4.1 mm Hg relative to the control group at 6 weeks. Storgaard et al recruited people with COPD and hypoxic respiratory failure. Hypercapnia was not an inclusion criteria but mean PaCO 2 at baseline was 48.8 mm Hg.…”

Nasal high‐flow therapy: Established roles and emerging opportunities

“…Storgaard et al . showed improvements in dyspnoea, endurance and quality of life with the application of NHF for an average of 6 h per day for 12 months in the home setting in subjects with previous exacerbating COPD . The improvement in dyspnoea scores was most apparent at 3 months of treatment.…”

“…Furthermore, emerging evidence points to newer applications of humidification outside the acute setting. Clinical benefits of humidification have extended to patients with chronic lung disease, assessed in the domiciliary context over extended timeframes, with two randomized controlled trials demonstrating promising reductions in the rates of infective exacerbation and/or hospital admission …”

“…Ease of use and patient comfort may be drivers of these uptake patterns. Conversely, despite promising (but not conclusive) data for reduced exacerbation rates and symptom improvement, the appearance of NHF in the domiciliary setting in the management of chronic obstructive and/or suppurative lung disease has gathered little real‐world momentum. Nonetheless, chronic disease management priorities identify improving quality of life and reducing disease exacerbations/hospitalizations as key objectives.…”