Nasal high-flow therapy: a novel treatment option for hypercapnic COPD patients

According to a German study, nasal high-flow (NHF) therapy might be a valuable addition to the existing oxygen delivery devices, particularly in COPD patients that cannot tolerate a mask [1].

NHF is a promising novel oxygen delivery device that allows a high flow of a heated and humidified gas mixture, thereby promoting higher and more stable inspiratory oxygen fraction values and generating a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance [2]. Stable COPD patients could benefit from its application through a reduction of anatomical dead space and an improvement in mucociliary clearance in conducting airways.

After the positive effects of a pilot study, Dr Jens Bräunlich (Kliniken Aurich-Emden-Norden, Germany) and his team compared NHF with non-invasive ventilation (NIV) in 102 patients with chronic hypercapnic COPD from 14 sites. The primary endpoint was pCO2 changes from baseline blood gas. In addition, lung function, quality of life, and changes in the 6-minute walk test were assessed as secondary endpoints. Patients were allocated to receive NHF or NIV. After 6 weeks, there was a crossover and patients received the other oxygen delivery device.

During treatment with NHF, pCO2 levels decreased by 4.7% compared with 7.1% during treatment with NIV. However, the difference between both devices of 1.4 mmHg was not statistically significant (P=0.12). Both devices improved lung function and quality of life with no differences between the devices, but only NIV led to an increase in the 6-minute walk test.

Dr Bräunlich concluded that NHF may constitute an alternative to NIV in COPD patients with stable chronic hypercapnia, especially in those rejecting NIV or not tolerating a face mask.

 

1. 
   
   1. Bräunlich J. Nasal high-flow versus non-invasive ventilation in patients with chronic hypercapnic COPD. Abstract 4350, ERS International Virtual Congress 2020, 7-9 Sept.
   2. Ischaki E, et al. Eur Resp Rev 2017;26(145):170028.

 



Posted on 29 October 2020