https://doi.org/10.4081/monaldi.2025.3269
Real-world data on home high-flow nasal cannula oxygen therapy in end-stage respiratory disease
Submitted: November 20, 2024
Accepted: February 13, 2025
Published: February 24, 2025
Accepted: February 13, 2025
Abstract Views: 209
PDF_EARLY VIEW: 48
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
High-flow nasal oxygen therapy (HFNOT) is a cornerstone treatment modality in severe acute hypoxemic respiratory failure, with benefits in improving oxygen deficit while normalizing breathing rate and having an effect on airway humidification. These physiological effects indicate a potential benefit in end-stage chronic respiratory failure. We aimed to assess the clinical impact of home HFNOT in reducing both exacerbation rates and overall disease burden in end-stage chronic respiratory disease. We designed a retrospective study including patients followed in the pulmonology department of a tertiary center who started home HFNOT until June 2023. Pre- and post-home HFNOT exacerbations and hospital admissions were registered, and each patient served as their own control for the statistical analysis. In total, 36 patients were included in the study: 24 patients (66.7%) with interstitial lung disease and 12 (33.3%) with obstructive lung disease. Overall, the median titrated fraction of inspired oxygen was significantly lower in obstructive patients; no significant differences were found between groups regarding titrated airflow. Obstructive patients had a significantly higher number of pre-treatment exacerbations and hospital stays. Both clinical subgroups presented less median overall post-treatment exacerbations and hospital admissions vs. pre-treatment start. Although mortality was high, home treatment was well tolerated by most patients, with only one patient interrupting high-flow therapy due to intolerance. Home HFNOT proved to be an overall feasible treatment strategy for patients with end-stage respiratory disease. Obstructive lung disease patients benefited the most from the treatment, possibly due to hypercapnia correction.
Hebbink RHJ, Duiverman ML, Wijkstra PJ, Hagmeijer R. Upper airway pressure distribution during nasal high-flow therapy. Med Eng Phys 2022;104:103805.
DOI: https://doi.org/10.1016/j.medengphy.2022.103805
Coletti KD, Bagdure DN, Walker LK, et al. High-flow nasal cannula utilization in pediatric critical care. Respir Care 2017;62:1023-9.
DOI: https://doi.org/10.4187/respcare.05153
Franklin D, Babl FE, Schlapbach LJ, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med 2018;378:1121-31.
DOI: https://doi.org/10.1056/NEJMoa1714855
Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med 2017;195:1207-15.
DOI: https://doi.org/10.1164/rccm.201605-0916OC
Oczkowski S, Ergan B, Bos L, et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J 2022;59:2101574.
DOI: https://doi.org/10.1183/13993003.01574-2021
Gotera C, Díaz Lobato S, Pinto T, Winck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol 2013;19:217-27.
DOI: https://doi.org/10.1016/j.rppneu.2013.03.005
Bräunlich J, Köhler M, Wirtz H. Nasal highflow improves ventilation in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016;11:1077-85.
DOI: https://doi.org/10.2147/COPD.S104616
Biselli PJC, Kirkness JP, Grote L, et al. Nasal high-flow therapy reduces work of breathing compared with oxygen during sleep in COPD and smoking controls: a prospective observational study. J Appl Physiol 2017;122:82-8.
DOI: https://doi.org/10.1152/japplphysiol.00279.2016
Elshof J, Duiverman ML. Clinical evidence of nasal high-flow therapy in chronic obstructive pulmonary disease patients. Respiration 2020;99:140-53.
DOI: https://doi.org/10.1159/000505583
Weinreich UM, Juhl KS, Søby Christophersen M, et al. The Danish respiratory society guideline for long-term high flow nasal cannula treatment, with or without supplementary oxygen. Eur Clin Respir J 2023;10:2178600.
DOI: https://doi.org/10.1080/20018525.2023.2178600
Criner GJ, Criner LYH, George SA, et al. Feasibility of using daily home high-flow nasal therapy in copd patients following a recent COPD hospitalization. Chronic Obstr Pulm Dis 2022;9:4-14.
DOI: https://doi.org/10.15326/jcopdf.2021.0236
Zhang L, Wang Y, Ye Y, et al. Comparison of high-flow nasal cannula with conventional oxygen therapy in patients with hypercapnic chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2023;18:895-906.
DOI: https://doi.org/10.2147/COPD.S402506
Rea H, McAuley S, Jayaram L, et al. The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med 2010;104:525-33.
DOI: https://doi.org/10.1016/j.rmed.2009.12.016
Storgaard LH, Hockey H, Laursen BS, Weinreich UM. Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure. Int J Chron Obstruct Pulmon Dis 2018;13:1195-205.
DOI: https://doi.org/10.2147/COPD.S159666
Nagata K, Horie T, Chohnabayashi N, et al. Home high-flow nasal cannula oxygen therapy for stable hypercapnic COPD : a randomized clinical trial. Am J Respir Crit Care Med 2022;206:1326-35.
DOI: https://doi.org/10.1164/rccm.202201-0199OC
Weinreich UM, Storgaard LH. A real-life study of combined treatment with long-term non-invasive ventilation and high flow nasal cannula in patients with end-stage chronic obstructive lung disease. J Clin Med 2023;12:4485.
DOI: https://doi.org/10.3390/jcm12134485
Vega Pittao ML, Schifino G, Pisani L, Nava S. Home high-flow therapy in patients with chronic respiratory diseases: physiological rationale and clinical results. J Clin Med 2023;12:2663.
DOI: https://doi.org/10.3390/jcm12072663
Harada J, Nagata K, Morimoto T, et al. Effect of high‐flow nasal cannula oxygen therapy on exercise tolerance in patients with idiopathic pulmonary fibrosis: a randomized crossover trial. Respirology 2022;27:144-51.
DOI: https://doi.org/10.1111/resp.14176
Weinreich UM, Burchardt C, Huremovic J. The effect of domiciliary high flow nasal cannula treatment on dyspnea and walking distance in patients with interstitial lung disease – a pilot study. Chron Respir Dis 2022;19:147997312211370.
DOI: https://doi.org/10.1177/14799731221137085
Al Chikhanie Y, Veale D, Verges S, Hérengt F. The effect of heated humidified nasal high flow oxygen supply on exercise tolerance in patients with interstitial lung disease: a pilot study. Respir Med 2021;186:106523.
DOI: https://doi.org/10.1016/j.rmed.2021.106523
Bräunlich J, Köhler M, Wirtz H. Nasal high-flow (NHF) improves ventilation in patients with interstitial lung disease (ILD)—a physiological study. J Clin Med 2023;12:5853.
DOI: https://doi.org/10.3390/jcm12185853
Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care 2015;3:15.
DOI: https://doi.org/10.1186/s40560-015-0084-5
Garofalo E, Bruni A, Pelaia C, et al. Evaluation of a new interface combining high-flow nasal cannula and CPAP. Respir Care 2019;64:1231-9.
DOI: https://doi.org/10.4187/respcare.06871
Ejiofor BD, Carroll RW, Bortcosh W, Kacmarek RM. PEEP Generated by high-flow nasal cannula in a pediatric model. Respir Care 2019;64:1240-9.
DOI: https://doi.org/10.4187/respcare.06470
Sun Y, Dai B, Peng Y, Tan W, Zhao H. Factors affecting FiO2 and PEEP during high‐flow nasal cannula oxygen therapy: a bench study. Clin Respir J 2019;13:758-64.
DOI: https://doi.org/10.1111/crj.13087
Bräunlich J, Goldner F, Wirtz H. Nasal highflow eliminates CO 2 from lower airways. Respir Physiol Neurobiol 2017;242:86-8.
DOI: https://doi.org/10.1016/j.resp.2017.03.012
Biselli P, Fricke K, Grote L, et al. Reductions in dead space ventilation with nasal high flow depend on physiological dead space volume: metabolic hood measurements during sleep in patients with COPD and controls. Eur Respir J 2018;51:1702251.
DOI: https://doi.org/10.1183/13993003.02251-2017
Piquilloud L, Olivier PY, Richard JC, et al. High flow nasal cannula improves breathing efficiency and ventilatory ratio in COPD patients recovering from an exacerbation. J Crit Care 2022;69:154023.
DOI: https://doi.org/10.1016/j.jcrc.2022.154023
Pavlov I, Plamondon P, Delisle S. Nasal high-flow therapy for type II respiratory failure in COPD: a report of four cases. Respir Med Case Rep 2017;20:87-8.
DOI: https://doi.org/10.1016/j.rmcr.2016.12.006
Plotnikow G, Thille AW, Vasquez D, et al. High-flow nasal cannula oxygen for reverting severe acute exacerbation of chronic obstructive pulmonary disease: a case report. Med Intensiva 2017;41:571-2.
DOI: https://doi.org/10.1016/j.medin.2016.11.009
Pisani L, Astuto M, Prediletto I, Longhini F. High flow through nasal cannula in exacerbated COPD patients: a systematic review. Pulmonology 2019;25:348-54.
DOI: https://doi.org/10.1016/j.pulmoe.2019.08.001
Squadrone E, Frigerio P, Fogliati C, et al. Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance. Intensive Care Med 2004;30:1303-10.
DOI: https://doi.org/10.1007/s00134-004-2320-7
Longhini F, Pisani L, Lungu R, et al. High-flow oxygen therapy after noninvasive ventilation interruption in patients recovering from hypercapnic acute respiratory failure: a physiological crossover trial. Crit Care Med 2019;47:e506-11.
DOI: https://doi.org/10.1097/CCM.0000000000003740
Jing G, Li J, Hao D, Wang T, et al. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: a pilot randomized controlled trial. Res Nurs Health 2019;42:217-25.
DOI: https://doi.org/10.1002/nur.21942
Cortegiani A, Crimi C, Noto A, et al. Effect of high-flow nasal therapy on dyspnea, comfort, and respiratory rate. Crit Care 2019;23:201.
DOI: https://doi.org/10.1186/s13054-019-2473-y
Ethics Approval
The study was conducted under the Declaration of Helsinki and was approved by the Ethics Committee of the Centro Hospitalar Universitário de São João (CHUSJ), Porto-Portugal (CES CHUSJ: 185/2023).How to Cite
Magalhães Ferreira, Pedro, Mariana Ribeiro, Miguel Gonçalves, and Carla Damas. 2025. “Real-World Data on Home High-Flow Nasal Cannula Oxygen Therapy in End-Stage Respiratory Disease”. Monaldi Archives for Chest Disease, February. https://doi.org/10.4081/monaldi.2025.3269.
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- P. Pirina, M. Budroni, S. Esposito, S. Ostera, M.F. Polo, L. Santoru, G. Madeddu, A.G. Fois, G.C. Ginesu, G. Padua, F. Tanda, F. Ginesu, Cytological and histological diagnosis of lung cancer in Sardinia and Italy in the 1990s , Monaldi Archives for Chest Disease: Vol. 67 No. 4 (2007): Pulmonary series
- Alberto Papi, Maria Sandra Magnoni, Carmelo Caio Muzzio, Gianmarco Benso, Andrea Rizzi, Phenomenology of COPD: interpreting phenotypes with the ECLIPSE study , Monaldi Archives for Chest Disease: Vol. 83 No. 1-2 (2016): Pulmonary series
- Grigoris Stratakos, Vlassis Vitsas, Nikos Koufos, Charalambos Zissis, Philip Emmanouil, Nikos Koulouris, Post-pneumonectomy and post-lobectomy syndromes: case series and review of the literature , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Sameer Vaidya, Dipti Gothi, Mahismita Patro, COPD sleep phenotypes: Genesis of respiratory failure in COPD , Monaldi Archives for Chest Disease: Vol. 92 No. 2 (2022)
- Michele Vitacca, Piero Ceriana, Bruno Balbi , Claudio Bruschi, Maria Aliani, Mauro Maniscalco, Francesco Fanfulla, Aldo Diasparra, Luigino Rizzello, Daniela Sereni, Antonio Spanevello, The respiratory rehabilitation Maugeri network service reconfiguration after 1 year of COVID-19 , Monaldi Archives for Chest Disease: Vol. 91 No. 4 (2021)
- Roberto Porta, Laura Comini, Luca Barbano, Luca Bianchi, Michele Vitacca, A case of obstructive sleep apnea syndrome associated with floppy eyelid syndrome: positive effect of CPAP therapy , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Andrea Zanini, Francesca Cherubino, Patrizia Pignatti, The use of roflumilast in COPD: a review , Monaldi Archives for Chest Disease: Vol. 79 No. 3-4 (2013): Pulmonary series - Supplement 1
- Bruno Sposato, Significant gas-exchange improvements reported after roflumilast in two cases of severe COPD , Monaldi Archives for Chest Disease: Vol. 79 No. 3-4 (2013): Pulmonary series - Supplement 1
- Ali Asghar Hemmati, Soheila Alboghobeish, Akram Ahangarpour, Chronic exposure to high fat diet exacerbates arsenic-induced lung damages in male mice: Possible role for oxidative stress , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- L. Fuso, G. Pagliari, V. Boniello, A. Trovè, F. Varone, A. Longobardi, S. Basso, L. Trodella, Autofluorescence bronchoscopy to identify pre-cancerous bronchial lesions , Monaldi Archives for Chest Disease: Vol. 63 No. 3 (2005): Pulmonary series
<< < 2 3 4 5 6 7 8 9 10 11 > >>
You may also start an advanced similarity search for this article.
