Abstract
Introduction The clinical benefit of high-flow nasal cannula (HFNC) on factors related to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients remains unclear. This meta-analysis aimed at synthesizing the available evidence on the efficacy of HFNC on exercise capacity, lung function, and other factors related to pulmonary rehabilitation in COPD patients. Methods Electronic databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science) were searched for randomized trials comparing with conventional oxygen therapy (COT) or noninvasive ventilation (NIV). Primary outcomes were respiratory rate, FEV1, tidal volume, oxygen partial pressure, total score of St. George's respiratory questionnaire, 6-minute walk test, and exercise endurance time. Results Ten trials met the criteria for inclusion. Combined data from six studies showed that HFNC showed a lower respiratory rate in COPD patients [mean difference -1.27 (95% CI: -1.65–(-0.89)]. Combined data from three studies showed a lower forced expiratory volume in one second (FEV1) in the group of HFNC. No difference in tidal volume was showed between the HFNC and control groups in COPD patients. No significant oxygen improvement between the HFNC groups and control groups. The total score of St. George's respiratory questionnaire was improved by the subgroup analysis of HFNC versus COT but no NIV. Two multicenter RCTs showed the six-minute walk test, and statistical results showed that the length of the six-minute walk capacity was increased after usage of HFNC compared to the control group [mean difference -8.65 (95% CI: -9.12–(-8.19)]. No increase of exercise capacity after usage of HFNC (mean difference -12.65). Conclusion In the first meta-analysis of the area, the current evidence did not show so much positive effect on tidal volume or oxygen improvement in COPD patients. Length of the six-minute walk capacity was increased after using HFNC, while other pulmonary rehabilitation parameters, namely, the score of St. George's respiratory questionnaire and exercise capacity show no increase in the group of HFNC. The variance in the quality of the evidence included in this meta-analysis highlights the need for this evidence to be followed up with further high-quality and more randomized trials.
Highlights
The clinical benefit of high-flow nasal cannula (HFNC) on factors related to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients remains unclear
Studies were eligible for inclusion if they involved an RCT using High-flow nasal cannula (HFNC) as a treatment method in Chronic obstructive pulmonary disease (COPD) patients, provided they reported at least one of the following outcomes: respiratory rate, FEV1, tidal volume, oxygen partial pressure, St
There were previous systematic reviews and meta-analyses in COPD-related pulmonary rehabilitation [28], and the most available evidence was about pulmonary exercise programs or muscle exercise
Summary
Chronic obstructive pulmonary disease (COPD) is a worldwide cause of mortality with a growing burden [1, 2]. It was reported that the overall risk of developing COPD by the age of 80 years has been calculated to be 28%, according to the population-based health administrative data [5] This disease progressively leads to chronic respiratory insufficiency, which can lead to hypoxia and hypercapnia [6], each of which is associated with poor outcomes [7, 8]. Observational studies suggest HFNC may improve the effects on exercise (showed by constant workload exercise testing) compared with oxygen [14] It could be a potential manner for improving pulmonary rehabilitation of COPD patients. The overall aim of this meta-analysis was to summarize the available evidence assessing the effects of delivering air or oxygen via HFNC compared with LTOT or NIV and to evaluate the effect of HFNC on pulmonary rehabilitation in COPD patients
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