Portable High-Flow Nasal Oxygen during Walking in Patients with Severe Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Respiration ◽  
2021 ◽  
pp. 1-7
Author(s):  
Annalisa Carlucci ◽  
Veronica Rossi ◽  
Serena Cirio ◽  
Manuela Piran ◽  
Giuditta Bettinelli ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Oxygen Saturation ◽  
High Flow ◽  
Portable Device ◽  
Chronic Obstructive ◽  
Inspiratory Capacity ◽  
Oxygen Supplementation ◽  
Obstructive Pulmonary Disease ◽  
Exercise Limitation ◽  
Severe Exercise

<b><i>Background:</i></b> High-flow nasal oxygen (HFNO) improves exercise capacity, oxygen saturation, and symptoms in patients with chronic obstructive pulmonary disease (COPD). Due to the need of electricity supply, HFNO has not been applied during free ambulation. <b><i>Objective:</i></b> We evaluated whether HFNO delivered during walking by a battery-supplied portable device was more effective than usual portable oxygen in improving exercise capacity in patients with COPD and severe exercise limitation. The effects on 6-min walking tests (6MWTs) were the primary outcome. <b><i>Methods:</i></b> After a baseline 6MWT, 20 stable patients requiring an oxygen inspiratory fraction (FiO<sub>2</sub>) &#x3c;0.60 during exercise, randomly underwent 2 6MWT carrying a rollator, under either HFNO with a portable device (HFNO test) or oxygen supplementation by a Venturi mask (Control) at isoFiO<sub>2</sub>. Walked distance, perceived dyspnea, pulse oximetry, and inspiratory capacity at end of the tests as well as patients’ comfort were compared between the tests. <b><i>Results:</i></b> As compared to baseline, walked distance improved significantly more in HFNO than in the control test (by 61.1 ± 37.8 and 39.7 ± 43.8 m, respectively, <i>p</i> = 0.01). There were no significant differences between the tests in dyspnea, peripheral oxygen saturation, or inspiratory capacity, but HFNO test was appreciated as more comfortable. <b><i>Conclusion:</i></b> In patients with COPD and severe exercise limitation, HFNO delivered by a battery-supplied portable device was more effective in improving walking distance than usual oxygen supplementation.

scholarly journals Nasal high-flow therapy reduces work of breathing compared with oxygen during sleep in COPD and smoking controls: a prospective observational study

2017 ◽  
Vol 122 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Paolo J. C. Biselli ◽  
Jason P. Kirkness ◽  
Ludger Grote ◽  
Kathrin Fricke ◽  
Alan R. Schwartz ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Work Of Breathing ◽  
High Flow ◽  
The Other ◽  
Chronic Obstructive ◽  
Oxygen Supplementation ◽  
Obstructive Pulmonary Disease ◽  
Mechanical Loads ◽  
Other Hand

Patients with chronic obstructive pulmonary disease (COPD) endure excessive resistive and elastic loads leading to chronic respiratory failure. Oxygen supplementation corrects hypoxemia but is not expected to reduce mechanical loads. Nasal high-flow (NHF) therapy supports breathing by reducing dead space, but it is unclear how it affects mechanical loads of patients with COPD. The objective of this study was to compare the effects of low-flow oxygen and NHF therapy on ventilation and work of breathing (WOB) in patients with COPD and controls during sleep. Patients with COPD ( n = 12) and controls ( n = 6) were recruited and submitted to polysomnography to measure sleep parameters and ventilation in response to administration of oxygen and NHF. A subset of six patients also had an esophageal catheter inserted for the purpose of measuring WOB. Patients with COPD had similar minute ventilation (V̇e) but lower tidal volumes than matched controls. With oxygen, [Formula: see text]was increased and V̇e was reduced in both controls and patients with COPD, but there was an increase in transcutaneous CO2 levels. NHF produced a greater reduction in V̇e and was associated with a reduction in CO2 levels. Although NHF halved WOB, oxygen produced only a minor reduction in this parameter. We conclude that oxygen produced little change in WOB, which was associated with CO2 elevations. On the other hand, NHF produced a large reduction in V̇e and WOB with a concomitant decrease in CO2 levels. Our data indicate that NHF improves alveolar ventilation during sleep compared with oxygen and room air in patients with COPD and therefore can decrease their cost of breathing. NEW & NOTEWORTHY Nasal high-flow (NHF) therapy can support ventilation in patients with chronic obstructive pulmonary disease during sleep by decreasing the work of breathing and improving CO2 levels. On the other hand, oxygen supplementation corrects hypoxemia, but it produces only a minimal reduction in work of breathing and is associated with increased CO2 levels. Therefore, NHF can be a useful method to assist ventilation in patients with increased respiratory mechanical loads.

Exercise Limitation in Chronic Obstructive Pulmonary Disease

2008 ◽  
Vol 4 (4) ◽  
pp. 258-269 ◽  
Author(s):  
Pierantonio Laveneziana ◽  
Karin Wadell ◽  
Katherine Webb ◽  
Denis O'Donnell
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Exercise Limitation

scholarly journals Alternative methods for assessing bronchodilator reversibility in chronic obstructive pulmonary disease

Thorax ◽  
2001 ◽  
Vol 56 (9) ◽  
pp. 713-720
Author(s):  
J Hadcroft ◽  
P M A Calverley
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Lung Volume ◽  
Tidal Flow ◽  
Airflow Limitation ◽  
Alternative Methods ◽  
Chronic Obstructive ◽  
Flow Limitation ◽  
Inspiratory Capacity ◽  
Obstructive Pulmonary Disease

BACKGROUNDBronchodilator reversibility testing is recommended in all patients with chronic obstructive pulmonary disease (COPD) but does not predict improvements in breathlessness or exercise performance. Two alternative ways of assessing lung mechanics—measurement of end expiratory lung volume (EELV) using the inspiratory capacity manoeuvre and application of negative expiratory pressure (NEP) during tidal breathing to detect tidal airflow limitation—do relate to the degree of breathlessness in COPD. Their usefulness as end points in bronchodilator reversibility testing has not been examined.METHODSWe studied 20 patients with clinically stable COPD (mean age 69.9 (1.5) years, 15 men, forced expiratory volume in one second (FEV1) 29.5 (1.6)% predicted) with tidal flow limitation as assessed by their maximum flow-volume loop. Spirometric parameters, slow vital capacity (SVC), inspiratory capacity (IC), and NEP were measured seated, before and after nebulised saline, and at intervals after 5 mg nebulised salbutamol and 500 μg nebulised ipratropium bromide. The patients attended twice and the treatment order was randomised.RESULTSMean FEV1, FVC, SVC, and IC were unchanged after saline but the degree of tidal flow limitation varied. FEV1 improved significantly after salbutamol and ipratropium (0.11 (0.02) l and 0.09 (0.02) l, respectively) as did the other lung volumes with further significant increases after the combination. Tidal volume and mean expiratory flow increased significantly after all bronchodilators but breathlessness fell significantly only after the combination treatment. The initial NEP score was unrelated to subsequent changes in lung volume.CONCLUSIONSNEP is not an appropriate measurement of acute bronchodilator responsiveness. Changes in IC were significantly larger than those in FEV1and may be more easily detected. However, our data showed no evidence for separation of “reversible” and “irreversible” groups whatever outcome measure was adopted.

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