High-flow therapy: beyond gas exchange!

Key facts

  • icon ERS INTERNATIONAL CONGRESS 2021
  • icon WITH MATHIEU DELORME
  • icon HIGH-FLOW THERAPY IN COPD
ERS-Congress-2020

HFT workshop at ERS 2021

Physiotherapist Mathieu Delorme shares his experience of, and best practice for, high-flow therapy, focussing on patient cases using HFT in different settings.

Content

High-flow therapy (HFT) is increasingly being used in the chronic setting for patients with COPD. In this workshop, our guest speaker Mathieu Delorme outlines how to best use HFT, as well as describing the potential benefits in patients with COPD and chronic respiratory failure.

In patients with chronic respiratory failure, HFT improves mucociliary clearance,1 improves rehabilitation outcomes,2 reduces hypercapnia,3 and reduces exacerbation rates.4,5 Interestingly, the physiological and clinical benefits of HFT may be observed without any oxygen requirement, but rather are due to the warmed and humidified air. Mathieu Delorme describes how HFT reduces dead space ventilation at flows of greater than 20 L/min,6 leading to reduced work of breathing and reduced CO2 retention.7 Mathieu Delorme describes how the humidification requirement is dependent on the flow rate, and there is no formal recommendation for the optimal hygrometry setting. Lower humidification settings have been shown to reduce patient comfort, yet settings must be adjusted to reach the optimal balance between safety and patient comfort. In addition, ambient temperature must be considered. Mathieu Delorme highlights how further research into the optimal HFT settings is required.  

In summary, home HFT provides benefits to patients with COPD and chronic respiratory failure and could be a particularly attractive option for patients who do not tolerate non-invasive ventilation.

References:

  1. Hasani A et al. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis. 2008;5(2):81–86.
  2. Bitos K et al. Effect of High-Flow Oxygen on Exercise Performance in COPD Patients. Randomized Trial. Front Med. 2021: doi.org/10.3389/fmed.2020.595450.
  3. Bräunlich J et al. Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD. Int J Chron Obstruct Pulmon Dis. 2019;14:1411–1421.
  4. Rea H et al. The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med. 2010;104(4):525–533.
  5. Storgaard LH et al. 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;13:1195–1205.
  6. Delorme M et al. Physiologic Effects of High-Flow Nasal Cannula in Healthy Subjects. Respir Care. 2020;65(9):1346–1354.
  7. Pisani L et al. Change in pulmonary mechanics and the effect on breathing pattern of high flow oxygen therapy in stable hypercapnic COPD. Thorax. 2017;72(4):373–375.

Speakers

Mathieu Delorme

Mathieu Delorme works at Université Paris-Saclay, Versailles, France as a physiotherapist. His research focuses on the physiological effects of high-flow therapy.

Looking for more information?

Home HFT: The expert’s voice

Dr. Salvador Díaz-Lobato, respiratory specialist, explains why home high-flow therapy is a useful treatment for COPD.
Read more

Research in home high flow therapy for COPD

Discover key findings from recent clinical research on the mechanisms of action of home high-flow therapy and the clinical outcomes in patients with COPD.
Read more

Home NIV in COPD

New prospects for the treatment of COPD patients
Read more