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Domiciliary nasal high-flow therapy in stable hypoxic COPD patients
Nasal high-flow (NHF) therapy has been shown to be a beneficial therapy for patients with acute respiratory failure in hospital and might be beneficial in patients with chronic hypoxemic respiratory failure if delivered at home. Storgaard et al. (Int J Chron Obstruct Pulmon Dis 2018;13:1195) performed a randomised controlled trial comparing NHF added to long-term oxygen therapy (LTOT+NHF) to LTOT alone in 200 moderately severe COPD patients. Compared with the previous year, patient-reported exacerbations increased from 2.90 to 4.95/patient/year in the LTOT alone group compared with a slight decrease from 3.23 to 3.12/patient/year in the LTOT+NHF group, resulting in a lower exacerbation frequency in the NHF group compared with the LTOT group (p<0.001). However, hospital admission and all-cause mortality were not different between the groups after 1 year. Exploratory analyses suggested that there was a dose response effect with a reduction in admissions in patients with high device usage. Furthermore, dyspnoea symptoms, health-related quality of life, arterial carbon dioxide pressure (PaCO2), and the 6 min walking distance improved in the NHF group compared with the LTOT group (all p<0.001). The study demonstrates that NHF is a potentially viable therapy in the home setting and may have physiological and clinical impact in patients with COPD on LTOT. Future studies should focus on high risk patients to assess the potential clinical impact on admission reduction.
CO2 clearance with nasal high-flow therapy in hypercapnic COPD patients is flow and leak dependent
Studies have shown that nasal …
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