Nasal High-Flow Therapy as an Alternative Treatment for Chronic Obstructive Pulmonary Disease (COPD)

Submitted By: Emily Dileonardo, BSc. SRT, Conestoga College

Chronic obstructive pulmonary disease (COPD) can create difficulties breathing and result in lung damage, with severe cases requiring mechanical ventilation (Tan et al., 2020). Hypercapnic respiratory failure is an associated complication with COPD, and currently, non-invasive ventilation is used to treat this condition (Tan et al., 2020). This current treatment regime has helped significantly improve COPD’s prognosis, yet this therapy’s tolerance is relatively low, and alternatives should be considered (Tan et al., 2020).

Non-Invasive Ventilation: The Current Standard of Care for COPD

When treating COPD patients, practitioners introduce non-invasive ventilation as a care plan to manage this disease’s symptoms. The introduction of this treatment has led to reduced mortality, lowered mechanical ventilation, and decreased hospitalization of COPD patients (Elliot, 2005). This treatment can be introduced earlier in the diagnosis and works to improve gas exchange and reduce the work required for breathing (Pisani, Asuto, Prediletto & Longhini, 2019). Although non-invasive ventilation is the current standard of care, this treatment is not always well tolerated by patients. Non-invasive ventilation can cause a range of side effects such as skin rashes or breakdown, eye irritation, and claustrophobia (Braunlich, Kohler & Wirtz, 2016). Currently, patients with COPD tend to fail under this treatment regime because of worsened respiratory function, or there is intolerance of the mask by the patient (Pisani et al., 2019).

Nasal High-Flow Therapy in COPD Treatment

A study conducted by McKinstry and colleagues (2019) suggested that nasal high-flow therapy could act as an alternative intervention when treating COPD and hypercapnia (McKinstry et al., 2019). The factors preventing patients from benefiting from non-invasive ventilation increase the need for a tolerable and easy to administer form of therapy (McKinstry et al., 2019).  McKinstry and colleagues (2019) suggest that the use of nasal high-flow therapy may be the needed intervention to fill the current unmet needs when caring for COPD (McKinstry et al., 2019). This treatment form can improve alveolar recruitment, lower resistance in the upper airway, and increase tidal volume and pressure (McKinstry et al., 2019). The single-center comparison trial was conducted in New Zealand with 24 hypercapnic COPD patients (McKinstry et al., 2019). The outcome of this study demonstrated that while non-invasive ventilation can show a more considerable reduction in hypercapnia among COPD patients, nasal high-flow therapy is still able to reduce the partial pressure of carbon dioxide (CO2). These results indicate that nasal high-flow can provide a comfortable and more accessible treatment for patients when non-invasive ventilation is not an option (McKinstry et al., 2019).

Benefits of Nasal High-Flow Therapy

Nasal high-flow therapy is an intervention method that delivers heated and humidified air or gas mixture to patients (Ischak, Panatazopoulos & Zakynthinos, 2017). A prior study conducted by Ischak and associates (2017) showed that patients with COPD could see the benefits from nasal high-flow therapy through a reduction in anatomical dead space, improvements in mucociliary clearance throughout the conducting airways, thus decreasing the effort needed to breathe (Ischak, Panatazopoulos & Zakynthinos, 2017). With the introduction of nasal high-flow therapy, practitioners can provide heated and humidified air to patients with COPD, preventing respiratory system insensible water loss and irritation to the ciliary mechanisms while also avoiding further inflammation (Pisani, Asuto, Prediletto & Longhini, 2019).

It has also been reconfirmed that nasal high-flow therapy can lead to a reduction in the partial pressure of CO2 in hypercapnic patients, similar to McKinstry’s findings (Braunlich et al., 2019). Pisani et al. (2019) also found that nasal high-flow therapy assists in CO2 washout in the pharyngeal dead space, benefiting patients with COPD. By improving these factors, nasal high-flow therapy is more tolerable and comfortable than non-invasive ventilation, providing a feasible treatment alternative (Pisani et al., 2019). The success of nasal high-flow therapy is similar to that of non-invasive ventilation, and both treatments can improve the quality of breathing in individuals diagnosed with COPD. In a study conducted by Tan et al. (2020), when comparing failure rates of treatment between nasal high-flow therapy and non-invasive ventilation, both interventions produced similar failure rates. However, nasal high-flow therapy is associated with less airway care interventions and lower skin breakdown reports than non-invasive ventilation (Tan et al., 2020). Overall, nasal high-flow therapy has the capacity to improve the quality of breathing in COPD patients and effectively manage and treat associated complications.

Changing Respiratory Practice for Patients with COPD

This research can change respiratory practice because it provides a suitable alternative for when non-invasive ventilation is poorly tolerated or not feasible. Failure of non-invasive ventilation is commonly attributed to patient discomfort, whereas nasal high-flow therapy may be more comfortable. Higher comfort levels and treatment tolerance without diminishing the benefits would expand treatment options for patients with COPD, thus allowing individuals to gain autonomy over their care and treatment in order to self-manage this disease more effectively and with greater success.

References

Braunlich, J., Dellweg, D., Bastian, A., Budweiser, S., Randerath, W., Triche, D., Bachmann, M., Kahler, C., Bayarassou, A., Mader, I., Geiseler, J., Norbert, K., Petroff, D., & Wirtz, H. (2019). Nasal high-flow versus non-invasive ventilation in patients with chronic hypercapnic COPD. International Journal of Chronic Obstructive Pulmonary Disease. 14, 1411-1421. DOI: https://doi.org/10.2147/COPD.S206111

Braunlich, J., Kohler, M. & Wirtz, H. (2016). Nasal highflow improves ventilation in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease. 11, 1077-1085. DOI: https://doi.org/10.2147/COPD.S104616   

Elliot, M. (2005). Non-invasive ventilation in acute exacerbations of COPD. European
Respiratory Review, 4, 36-42. DOI: https://doi.org/10.1183/09058180.05.00009405   

Ischaki, E., Panatazopoulos, I., & Zakynthinos, S. (2017). Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device. European Respiratory Review, 26. DOI: https://doi.org/10.1183/16000617.0028-2017

McKinstry, S., Singer, J., Baarsma, J.P., Weatherall, M., Beasley, R., & Fingleton, J. (2019). Nasal high-flow therapy compared with non-invasive ventilation in COPD Patients with chronic respiratory failure: A randomized controlled cross-over trial. Respirology, 24(11). DOI: https://doi.org/10.1111/resp.13575 

Pisani, L., Asuto, M., Prediletto, I., & Longhini, F. (2019). High flow through nasal cannula in exacerbated COPD patients: a systematic review. Pulmonology, 25(6), 348-354. DOI: https://doi.org/10.1016/j.pulmoe.2019.08.001  

Tan, D., Walline, J., H., Ling, B., Xu, Y., Sun, J., Wang, B., Shan, X., Wang, Y., Cao, P., Zhu, Q., Geng, P., & Xu, J. (2020). High-flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease patients after extubation: a multicenter, randomized controlled trial. Critical Care, 24(489). DOI: https://doi.org/10.1186/s13054-020-03214-9

[printfriendly]