ArticleThe Effects of Home High-Flow Nasal Cannula Oxygen Therapyon Clinical Outcomes in Patients with Severe COPD andFrequent Exacerbations

Ventilation Practitoner Christiaan7 Theunisse schreef als mede auteur mee aan dit artikel.

Abstract: Background: Chronic Obstructive Pulmonary Disease (COPD) is a disease withhigh morbidity and mortality globally. Exacerbations of COPD are major contributorsto disease progression and a decline in health-related quality of life (HRQoL). High-flownasal cannula (HFNC) oxygen therapy is an innovative therapy that provides humidifiedand heated blended air and oxygen through a nasal cannula. There is some preliminaryevidence supporting the effectiveness of HFNC in managing COPD exacerbations, butthere are limited data on its effectiveness when used at home for patients with stable, severeCOPD. The aim of the present study is to test the hypothesis that home HFNC can decreasethe COPD exacerbations rate and hospital admissions and improve HRQoL measures insevere COPD patients with frequent COPD exacerbations. Methods: In a prospectiveproof-of-concept interventional multicenter study, 40 GOLD stage III and IV COPD patientswith a high disease burden (≥2 exacerbations treated with antibiotics and/or corticosteroids) and ≥1 hospital admission in the last year were included. Patients were giveninstructions on the usage of HFNC by a ventilation practitioner during a group session.The flow rate was 25–30 L/min and FiO2 was 21–35%. Outcome measures included theCOPD exacerbations rate, hospital admissions, in-hospital days, Medical Research Councildyspnea (MRC) score, Clinical COPD Questionnaire (CCQ) score, Hospital Anxiety Depression Scale (HADS) scores and capillary pCO2. Repeated analysis of variance (ANOVA)was used to analyze the data. Significant effects identified in the ANOVA were furtherexamined using Student’s t-tests. Results: After 1 year, 27 patients could be evaluated. TheCOPD exacerbations rate decreased by 1.40 (mean difference ± SD: 1.40 ± 2.09; p = 0.002),hospital admissions decreased by 0.96 admissions per year (0.96 ± 1.37; p = 0.001), andin-hospital days decreased by 7.22 days (7.22 ± 9.26; p = 0.001). Capillary pCO2 decreasedby 0.02 kPa (0.02 ± 0.52; p = 0.85). The CCQ score decreased by 0.06 (0.06 ± 0.96; p = 0.76).The MRC dyspnea score decreased by 0.04 (0.04 ± 0.80; p = 0.81). The HADS anxiety scoredecreased by 0.63 (0.63 ± 3.12; p = 0.31). And finally, the HADS depression score decreasedby 0.32 (0.32 ± 3.48; p = 0.64). There was a significant difference between the normocapnic(capillary pCO2 < 6.0 kPa) group and the hypercapnic group in terms of change in theCCQ score (−0.24 ± 0.55 and 0.49 ± 1.32 decrease, respectively, p = 0.05) and the HADSdepression score (−0.76 ± 1.86 and 2.20 ± 4.75 decrease, respectively, p = 0.03) after 1 yearof HFNC treatment. Conclusions: One-year-long HFNC therapy significantly decreasedJ. Clin. Med. 2025, 14, 868 https://doi.org/10.3390/jcm14030868J. Clin. Med. 2025, 14, 868 2 of 14the COPD exacerbations rate, hospital admissions, and in-hospital days in severe COPDpatients with a high disease burden and frequent COPD exacerbations irrespective of themhaving hypercapnia and with the HRQoL measures only improving in the hypercapnicgroup. This may imply that severe COPD patients with a high disease burden and frequentCOPD exacerbations, irrespective being hypercapnic, are candidates for treatment withhome HFNC oxygen therapy.

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