Nasal high-flow oxygen therapy yields benefit in severe ILD
Patients with severe interstitial lung disease who received heated and humidified nasal high-flow oxygen therapy had significant improvements in endurance, physiologic parameters and sensations during exercise.
“In daily pulmonary clinical and rehabilitation practice, we frequently meet ILD patients being limited during exercise. We were looking for new strategies to improve functional capacity and exercise training tolerance while correcting oxygen saturation and reducing signs of dyspnea and fatigue in these patients,” Yara Al Chikhanie, PhD, from the Dieulefit Santé Cardiopulmonary Rehabilitation Centre in Rhône-Alpes, France, and Samuel Verges, PhD, senior scientist at UM Sports Pathologies at Hôpital Sud in Grenoble, France, told Healio. “The [nasal high-flow oxygen] method was previously proven efficient in COPD patients and could be implemented during exercise training in ILD patients.”
Researchers enrolled 25 patients (mean age, 72.8 years; 10 women) with a diagnosis of severe ILD. All patients performed three constant-load cycling exercise tests until exhaustion or for 20 minutes under room air, oxygen supplementation (4 L/min) and heated and humidified nasal high-flow oxygen (30-50 L/min at 34°C) breathing conditions.
The researchers observed significant improvements in patients’ endurance time when exercising with oxygen supplementation compared with room air and when exercising with nasal high-flow oxygen compared with oxygen supplementation (618 seconds vs. 369 seconds; P < .001) and room air (618 seconds vs. 171 seconds; P < .001).
In addition, researchers observed delays in kinetics of oxygen desaturation, chronotropic response, dyspnea and leg fatigue sensations with nasal high-flow oxygen.
Compared with room air or oxygen supplementation, oxygen desaturation was less severe at exhaustion with nasal high-flow oxygen, while heart rate, dyspnea and leg fatigue were similar between all breathing conditions.
Only four patients were able to cycle for 20 minutes with nasal high-flow oxygen. Because this was the maximal duration of the protocol, it meant these patients could have continued cycling. According to the researchers, this shows an impressive exercise capacity gain with these patients with nasal high-flow oxygen.
“Nasal high-flow oxygen appears to be a novel and attractive strategy to enhance performance while reducing symptoms in ILD patients,” Chikhanie and Verges told Healio. “More studies are needed to better understand the mechanisms underlying the substantial effect of nasal high-flow oxygen on exercise tolerance in ILD patients, and future studies should also consider the interest of using nasal high-flow oxygen in order to improve the feasibility and efficiency of exercise training in this population of severe respiratory patients.”
For more information:
Samuel Verges, PhD, can be reached at sverges@chu.grenoble.fr.