Stable Hypercapnic COPD May Benefit From At-Home High-Flow Nasal Cannula Oxygen Therapy
High-flow nasal cannula oxygen therapy for COPD has been shown to be effective in the acute setting.
At-home treatment with high-flow nasal cannula (HFNC) oxygen therapy for 6 weeks in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD) improved health-related quality of life (HRQOL) and reduced hypercapnia according to a study published in the Annals of the American Thoracic Society.
Kazuma Nagata, MD, of the department of respiratory medicine, Kobe City Medical Center General Hospital in Japan, and colleagues conducted a multicenter, randomized crossover trial (ClinicalTrials.gov identifier: NCT02545855) comparing HFNC plus long-term oxygen therapy (HFNC/LTOT) with LTOT only in 32 adults with stable hypercapnic COPD.
Participants were randomly assigned to either 6 weeks of HFNC/LTOT using myAIRVO2® (Fisher & Paykel Healthcare; Auckland, New Zealand) followed by an additional 6 weeks of LTOT-only therapy or the reverse. The primary outcome was the change in QOL as assessed by St. George's Respiratory Questionnaire for COPD (SGRQ-C). The investigators used a linear mixed effect model to account for treatment effect, time effect, allocation effect, and participant effect.
A total of 29 participants completed the study. Data showed that HFNC/LTOT treatment improved the mean total SGRQ-C score by 7.8 points (P <.01), the arterial partial pressure of carbon dioxide (adjusted treatment effect –4.1 mm Hg), and the median nocturnal transcutaneous carbon dioxide pressure (adjusted treatment effect, –5.1) compared with LTOT only.
However, HFNC/LTOT did not improve the arterial partial pressure of oxygen, dyspnea, spirometry measures, lung volumes, the 6-minute walk test, or physical activity. The most frequently encountered adverse effect of HFNC therapy was nocturnal sweating, which occurred in 20.7% of participants. During the trial, 4 severe adverse events occurred (2 in each group), but these were deemed not to be the result of therapy.
Growing evidence indicates that HFNC oxygen therapy is beneficial in the acute setting. These findings suggest that the benefits of HFNC may apply to at-home therapy as well.
Nagata K, Kikuchi T, Horie T, et al. Domiciliary high-flow nasal cannula oxygen therapy for stable hypercapnic COPD patients: a multicenter, randomized crossover trial [published online December 28, 2017]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201706-425OC