Abstract
BackgroundPatients with fibrotic interstitial lung disease (FILD) often experience gas exchange abnormalities and ventilatory limitations, resulting in reduced exercise capacity. High-flow nasal cannula (HFNC) oxygen therapy is a novel treatment, whose physiological beneficial effects have been demonstrated in various clinical settings. We hypothesized that HFNC oxygen therapy might be superior to conventional oxygen therapy for improving exercise capacity in FILD patients.MethodsWe performed a prospective randomized controlled crossover trial with a high-intensity constant work-rate endurance test (CWRET) using HFNC (50 L/min, FiO2 0.5) and a venturi mask (VM) (15 L/min, FiO2 0.5) for oxygen delivery in FILD patients. The primary outcome variable was endurance time. The secondary outcome variables were SpO2, heart rate, Borg scale (dyspnea and leg fatigue), and patient’s comfort.ResultsSeven hundred and eleven patients were screened and 20 eligible patients were randomized. All patients completed the trial. The majority of patients were good responders to VM and HFNC compared with the baseline test (VM 75%; HFNC 65%). There was no significant difference in endurance time between HFNC and VM (HFNC 6.8 [95% CI 4.3–9.3] min vs VM 7.6 [95% CI 5.0–10.1] min, p = 0.669). No significant differences were found in other secondary endpoints. Subgroup analysis with HFNC good responders revealed that HFNC significantly extended the endurance time compared with VM (VM 6.4 [95%CI 4.5–8.3] min vs HFNC 7.8 [95%CI 5.8–9.7] min, p = 0.046), while no similar effect was observed in the VM good responders.ConclusionsHFNC did not exceed the efficacy of VM on exercise capacity in FILD, but it may be beneficial if the settings match. Further large studies are needed to confirm these findings.Trial registrationUMIN-CTR: UMIN000021901.
Highlights
Patients with fibrotic interstitial lung disease (FILD) often experience gas exchange abnormalities and ventilatory limitations, resulting in reduced exercise capacity
We investigated the relationship between venturi mask (VM)/High-flow nasal cannula (HFNC) non-responders and pulmonary hypertension (PH) assessed by either echocardiography or right heart catheterization [19, 20]
HFNC did not exceed the efficacy of VM in endurance time (HFNC 6.8 [95% confidence interval (CI) 4.3–9.3] min vs VM 7.6 [95% CI 5.0– 10.1] min, p = 0.669)
Summary
Patients with fibrotic interstitial lung disease (FILD) often experience gas exchange abnormalities and ventilatory limitations, resulting in reduced exercise capacity. There is a growing body of evidence that supplemental oxygen is effective in improving the exercise capacity of FILD patients. A previous doubleblind, placebo-controlled, randomized crossover trial demonstrated that ambulatory oxygen did not improve exercise capacity and exertion dyspnea compared with placebo-air [6]. A recent prospective, open-label, crossover randomized controlled trial (AmbOx) showed that supplemental oxygen improves exercise capacity and exertional dyspnea compared with placebo-air in FILD patients [7]. Another randomized crossover trial showed that supplemental oxygen provided through an oxygen conserving device improved endurance time and desaturation in FILD patients [8]. Short-burst supplemental oxygen during exercise is becoming common practice for FILD patients [9]
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