High-Flow Nasal Therapy at Home Post Hospitalization for COPD Exacerbation

Following hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD), high-flow nasal therapy (HFNT) at home on a daily basis for up to 3 months is a viable treatment option for COPD patients, according to study results recently published in the journal Chronic Obstructive Pulmonary Diseases. Study investigators noted that enhancements in disease-specific quality of life, respiratory symptoms, and 6-minute walking distance (MWD) that warranted follow-up with a prospective multicenter controlled clinical trial.

In individuals hospitalized with acute hypoxemic respiratory failure, HFNT has proven helpful. However, the benefit of this treatment post hospitalization has not been robustly investigated.

In the recently published exploratory study, 28 patients completed a 90-day open-labeled pilot study of HFNT, in which the safety and potential for daily home use for COPD treatment was assessed. The study participants were aged 40 years or more and had a history of recent prior hospitalization secondary to COPD exacerbation. None of the COPD patients who completed the trial were intolerant. Participants averaged 6.8 hours on HFNT daily vs the recommended 4 hours. An increase of 24 meters was observed in 6-minute walking distance.

Although no changes were seen in daily peak-flow measurements, spirometry readings, ABGs, or ratings of the Borg dyspnea scale, 25 of 28 patients noted limited to substantial improvement in feelings of breathlessness by the end of the study.

Other measures that remained unchanged during the course of the study included nasal congestion and complaints of sore throat. Measures that trended downward included reports of wheezing/cough and sputum volume, color, and consistency. Participants with white/yellow sputum changed to no sputum production, and those with thick/thin sputum changed to watery or no sputum production. Even those participants who made 1 tablespoonful or more of sputum transitioned to producing lower levels or none. Although the reasons underlying this decrease in sputum production remain to be elucidated, use of heated/humidified HFNT has been linked to sputum attenuation and abatement. The authors hypothesize that HFNT users could cough more easily and thus clear secretions, although this claim is unsupported in the current study.

Authors noted that this study was limited by its small sample of participants, all drawn from 1 clinical center; the fact that patients served as their own control; and the analysis of breathlessness using the visual analog/Likert scales, which have yet to validated for this purpose.

Disclosure: This research was supported by Fisher & Paykel. Please see the original reference for a full list of disclosures.

Reference

Criner, GJ, Criner, LH, George, SA, et al. Feasibility of using daily home high-flow nasal therapy in COPD patients following a recent COPD hospitalization. Chronic Obstructive Pulmonary Diseases. Published online on November 4, 2021. doi:10.15326/jcopdf.2021.0236