In a German study, nasal high-flow (NHF) therapy and non-invasive ventilation (NIV) performed equally well in people with cCOPD with hypercapnia1. NHF could therefore be a valuable addition to existing oxygen delivery devices. This is particularly important for COPD patients who cannot tolerate a mask.
NHF is a promising new type of oxygen delivery device. It allows a high flow rate of heated and humidified gas mixtures. It thus promotes higher and more stable fractions of inspired oxygen (FiO2) values and generates positive airway pressure (PAP), which can reduce the work of breathing and improve patient comfort and tolerability2. Stable COPD patients could benefit from reduced anatomical dead space and improved mucociliary clearance in the conducting airways.
A pilot study delivered positive results. Therefore, Dr. Jens Bräunlich (Kliniken Aurich-Emden-Norden, Germany) and his team compared NHF and NIV in 102 patients with chronic hypercapnic COPD from 14 locations. The primary endpoint of the study was the change in pCO2 levels compared to the baseline blood gas values. Pulmonary function, quality of life, and changes in the 6-minute walk test were also evaluated as secondary endpoints. Patients were assigned to receive NHF or NIV. After 6 weeks, the test subjects changed the oxygen delivery devices.
During NHF treatment, pCO2 levels decreased by 5.7%, compared to -7.2% during NIV treatment. However, the difference between the two devices was not statistically significant at 1.4 mmHg (P=0.12). Both devices improved lung function and quality of life, but only NIV led to an increase in the 6-minute walk test.
The study shows: NHF could be an alternative to NIV in COPD patients with stable chronic hypercapnia. Especially in patients who refuse NIV or cannot tolerate a face mask.
1. brownish J. Nasal high-flow versus non-invasive ventilation in patients with chronic hypercapnic COPD. ERS International Virtual Congress 2020, 7-9 September, 2020.
2. Ischaki E, et al Eur Resp Rev 2017;26(145):170028