Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

Sheng-Yeh Shen,Lan-Fang Tung,Hui-Hsuan Shih,Yen-Ting Chen,Chia-Te Yen,Shu-Chuan Ho

doi:10.1186/s12931-020-1328-z

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is airway inflammation characterized and low daily physical activity. Most pulmonary rehabilitation (PR) programs are often provided to stable patients, but fewer training programs are specific for hospitalized patients with acute exacerbation (AE). Patients with AECOPD experience increased dyspnea sensations and systemic inflammation during exercise training. High-flow nasal therapy (HFNT) reduces the minute volume, lowers the respiratory rate, and decreases the work of breathing. However, it is not clear whether HFNT is efficient during exercise training. In this study, we investigated the effects of HFNT during exercise training in an early PR program among hospitalized patients with severe AECOPD.MethodsWe enrolled COPD patients hospitalized due to AE. They were randomized into two groups according to their status into HFNT PR and non-HFNT PR groups. This study collected basic data, and also assessed a pulmonary function test, 6-min walking test, blood inflammatory biomarkers, and arterial gas analysis at the baseline, and at 4 and 12 weeks of the intervention. Data were analyzed using SPSS statistical software.ResultWe recruited 44 AECOPD patients who completed the 12-week PR program. The HFNT PR program produced significant improvements in exercise tolerance as assessed by the 6-min walking distance (6MWD), reduced dyspnea sensations in the modified Medical Research Council (mMRC), and decreased systemic inflammation as evidenced by the a lower C-reactive protein (CRP) level. A reduction in the length of hospitalization was achieved with PR in the 1-year follow-up in the two groups. The HFNT PR group showed better trends of reduced air trapping in the delta inspiration capacity (IC) and an increased quality of life according to the COPD assessment test (CAT) than did the non-HFNT PR group.ConclusionsHFNT during exercise training in early PR increases exercise tolerance and reduces systemic inflammation in hospitalized patients with severe AECOPD.

Highlights

Chronic obstruction pulmonary disease (COPD) patients have lower daily physical activity [1], and are characterized by low-grade systemic inflammation caused by circulating inflammatory mediators
With the exception of the smoking status, modified Medical Research Council (mMRC), Chronic obstructive pulmonary disease (COPD) assessment test (CAT), and BODE there were no significant differences between the two groups
This study showed some significant outcomes after High-flow nasal therapy (HFNT) early pulmonary rehabilitation (PR) in patients with AECOPD: improved exercise tolerance in the 6-min walking distance (6MWD) after 4 and 12 weeks of the PR program, and decreased dyspnea sensation in mMRC and inflammation as evidenced by the C-reactive protein (CRP) level after 12 weeks of PR

Summary

Introduction

Chronic obstruction pulmonary disease (COPD) patients have lower daily physical activity [1], and are characterized by low-grade systemic inflammation caused by circulating inflammatory mediators. AECOPD requiring hospitalization is associated with poor outcomes, including accelerated declines in muscle strength [6] and lung function [7], a reduced health status and quality of life (QOL) [8], accelerated disease progression [9], a significant risk of recurrent exacerbations, and an increased risk of mortality [10, 11]. It was reported in the United Kingdom that 43% of patients hospitalized with AECOPD were readmitted and 12% died within 90 days.

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