Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study

Abstract

Background and objective: We hypothesized that by reducing respiratory work and improving gas exchange, nasal high flow (NHF) would improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) following respiratory exacerbation. Methods: This was a monocentric, randomized, controlled crossover study. Patients with severe to very severe COPD carried out two high-intensity constant work-rate exercise tests (CWRET) with and without NHF on two consecutive days. The primary outcome was the mean difference in endurance time between both conditions. The secondary aims included vastus lateralis oxygenation (StO 2 ), dyspnoea, leg discomfort, maximal inspiratory pressure (MIP), transcutaneous CO 2 pressure (PtcCO 2 ), respiratory rate (RR), heart rate (HR) and pulsed O 2 saturation (SpO 2 ), as well as the patients' opinions of the device. Results: A total of 19 patients were included (mean forced expiratory volume in 1 s = 28.7 AE 10.8%, age = 62.1 AE 9.1 years). No significant differences in endurance time during the CWRET were found between the two test conditions (−66.58 (95% CI: −155.9 to 22.7) s, P = 0.12). StO 2 , PtCO 2 and HR were reduced at the end of the exercise with NHF (−2.1% (95% CI: −4.3 to −0.0); −1.3 mm Hg (95% CI: −2.5 to −0.2); −2.7 bpm (95% CI: −5.0 to −0.5), respectively, P ≤ 0.05). No significant differences were found for any of the other secondary outcomes. Half of the patients evaluated the device as being moderately to very uncomfortable.Conclusion: NHF during exercise did not increase endurance time in patients with COPD following exacerbation.Clinical trial registration: NCT03058081 at clinicaltrials. gov Key words: chronic obstructive pulmonary disease, exercise, muscle oxygenation, nasal high flow, pulmonary rehabilitation.

Year in Review 2019: High-Flow Nasal Cannula Oxygen Therapy for Adult Subjects

“…The authors reported that there were no improvements in endurance time or symptoms, such as dyspnea and leg discomfort, with HFNC utilization. 9 They did note, however, that transcutaneously measured partial pressure of carbon dioxide and heart rate during exercises were lower in the HFNC group than in the group receiving O 2 therapy. 9 The main differences between these 2 studies were the oxygen device in the control group and the S pO 2 goal during exercises.…”

“…9 They did note, however, that transcutaneously measured partial pressure of carbon dioxide and heart rate during exercises were lower in the HFNC group than in the group receiving O 2 therapy. 9 The main differences between these 2 studies were the oxygen device in the control group and the S pO 2 goal during exercises. In the study by Cirio et al, 54 an air-entrainment mask was utilized with the same F IO 2 as HFNC.…”

Contemporary Concise Review 2019: Chronic obstructive pulmonary disease

“…Using a randomized cross‐over trial design, these investigators found that the use of NIMV in these COPD patients with stable hypercapnic respiratory failure led to a 39% increase in endurance time on a cycle ergometer than oxygen therapy alone with lower arterial PaCO 2 and better oxygenation. On the other hand, as noted by Prieur et al ., nasal high‐flow therapy (at 60 L/min) did not improve exercise endurance during a high‐intensity exercise test, although it had a slight salutary effect on arterial PCO 2 . Thus, NIMV but not nasal high‐flow therapy can be recommended for patients with persistent hypercapnia during pulmonary rehabilitation.…”

“…On the other hand, as noted by Prieur et al, nasal high-flow therapy (at 60 L/min) did not improve exercise endurance during a high-intensity exercise test, although it had a slight salutary effect on arterial PCO 2 . 18 Thus, NIMV but not nasal high-flow therapy can be recommended for patients with persistent hypercapnia during pulmonary rehabilitation.…”

Nasal high‐flow therapy: Established roles and emerging opportunities

“…The recent study of Prieur et al . explored the acute effects of NHF in 19 subjects with advanced COPD on exertional capacity within 7 days of a hospital exacerbation in a crossover design . They demonstrated no effect on symptoms of dyspnoea or exercise capacity in this context.…”