Patients with chronic hypercapnic COPD may benefit from nasal high-flow therapy

Nasal high-flow oxygen therapy may be an alternative to noninvasive ventilation in patients with chronic hypercapnic COPD, according to data presented at the virtual European Respiratory Society International Congress.

“Despite the encouraging results of noninvasive ventilation in chronic hypercapnic COPD patients, it is also evident that some patients do not tolerate noninvasive ventilation or do not benefit from it. We conducted a study in which COPD patients with stable, chronic hypercapnia were treated with noninvasive ventilation and nasal high-flow to compare effectiveness,” according to Jens Bräunlich, MD, of the department of respiratory medicine at the University of Leipzig, Germany, and colleagues.

Researchers conducted a randomized, controlled, multicenter, crossover study that enrolled 102 patients (mean age, 65 years; 61% women) with COPD with chronic stable daytime hypercapnia (partial pressure of carbon dioxide [pCO2] > 50 mm Hg) at 14 German centers. Patients received nasal high-flow therapy for 6 weeks followed by noninvasive ventilation for 6 weeks, or vice versa, from 2011 to 2016.

Primary outcome was pCO2 change from baseline. Secondary endpoints were changes in blood gas, lung function, quality of life, 6-minute walking test and duration of device use.

Nasal high-flow therapy resulted in pCO2 levels decreasing by 4.7% (95% CI, 1.8-7.5; P = .002) and noninvasive ventilation resulted in a decrease of 7.1% (95% CI, 4.1-10.1; P < .001). The difference in pCO2 change between nasal high-flow therapy and noninvasive ventilation groups was 1.4 mm Hg (95% CI, –3.1 to 0.4; P = .12), Bräunlich said during his presentation.

Both nasal high-flow therapy and noninvasive ventilation had positive effects on blood gases (2.8; 95% CI, 4.6 to 1.1; P = .002 and 4.2; 95% CI, 6 to 2.4; P < .001, respectively) and in total respiratory scores on the St. George’s Respiratory Questionnaire (6.2; 95% CI, 8.9 to –3.5; P <.001 and 6.9; 95% CI, 9.6 to 4.2; P < .001) and Severe Respiratory Insufficiency Questionnaire (3.5; 95% CI, 1.1-5.8; P = .003 and 2.7; 95% CI, 0.3-5; P = .025).

According to Bräunlich, one possible reason for the difference between nasal high-flow devices and noninvasive ventilation could be that researchers used a flow of 20 L per minute with the nasal high-flow device compared with 20 mg expiratory positive airway pressure.

“... We see nasal high flow as an alternative way to ventilate patients with COPD and stable hypercapnia, especially in patients who do not tolerate noninvasive ventilation,” Bräunlich said.