Impact of high-flow oxygen therapy during exercise in idiopathic pulmonary fibrosis: a pilot crossover clinical trial

Diana Badenes-Bonet,Oswaldo Antonio Caguana,Rosa Vázquez-Sánchez,Xavier Duran,Pilar Cejudo,Eva Balcells,Jose Antonio Rodríguez-Portal,Roberto Chalela,Joaquim Gea,Diego Agustín Rodriguez-Chiaradia,Anna Rodó-Pin,Clara Martín-Ontiyuelo

doi:10.1186/s12890-021-01727-9

Abstract

BackgroundSupplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Although high-flow nasal cannula oxygen therapy (HFNC) improves oxygenation in other respiratory diseases, its impact on exercise performance has never been evaluated in IPF patients. We hypothesized that HFNC may improve exercise capacity in IPF subjects compared to SOT.MethodsThis was a prospective, crossover, pilot randomized trial that compared both oxygenation methods during a constant submaximal cardiopulmonary exercise test (CPET) in IPF patients with exertional oxygen saturation (SpO2) ≤ 85% in the 6-min walking test. The primary outcome was endurance time (Tlim). Secondary outcomes were muscle oxygen saturation (StO2) and respiratory and leg symptoms.ResultsTen IPF patients [71.7 (6) years old, 90% males] were included. FVC and DLCO were 58 ± 11% and 31 ± 13% pred. respectively. Tlim during CPET was significantly greater using HFNC compared to SOT [494 ± 173 vs. 381 ± 137 s, p = 0.01]. HFNC also associated with a higher increase in inspiratory capacity (IC) [19.4 ± 14.2 vs. 7.1 ± 8.9%, respectively; p = 0.04], and a similar trend was observed in StO2 during exercise. No differences were found in respiratory or leg symptoms between the two oxygen devices.ConclusionsThis is the first study demonstrating that HFNC oxygen therapy improves exercise tolerance better than SOT in IPF patients with exertional desaturation. This might be explained by changes in ventilatory mechanics and muscle oxygenation. Further and larger studies are needed to confirm the benefits of HFNC in IPF patients and its potential usefulness in rehabilitation programs.

Highlights

Supplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF)
No significant differences were present between those patients randomized to initiate the submaximal cardiopulmonary exercise test (CPET) with high-flow nasal cannula oxygen therapy (HFNC) and those who began with SOT
The direct relationship observed in the present study between differences in Endurance time (Tlim) and in task failure Peripheral oxygen saturation (SpO2) between both submaximal exercises would indicate that oxygenation has probably played some role in the better improvement in exercise capacity observed with HFNC

Summary

Introduction

Supplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Oxygen therapy using standard delivery devices (nasal cannula, Venturi masks) (SOT) has recently been demonstrated to improve exercise capacity, increasing endurance time, reducing blood oxygen desaturation and dyspnea and even improving skeletal muscle metabolism in IPF patients [9, 10]. It is broadly recognized in clinical practice that SOT has important limitations to achieving optimal levels of oxygenation in such patients during exercise [11]. Secondary end-points were peripheral muscle oxygen saturation (StO2) during exercise as well as dyspnea and leg symptoms during exertion

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Conclusion