Sleep and Daytime Use of Humidified Nasal High-flow Oxygen in COPD Outpatients

Not Applicable

Completed

Brief Summary: Humidified Nasal High-flow with Oxygen (HNHF-O2) therapy has been reported to have acute beneficial effects in patients with hypoxemic respiratory failure who have been hospitalized. The usefulness of this therapy in the outpatient setting is unproven. This pilot study will test the feasibility of using this therapy in the outpatient setting and its effects on sleep.

Detailed Description: Humidified Nasal High-flow with Oxygen (HNHF-O2) therapy has been reported to have acute beneficial effects in patients with hypoxemic respiratory failure. HNHF-O2 may be beneficial in patients with COPD and chronic impairments in gas exchange, both hypoxemia as well as hypercapnia. HNHF-O2 may decrease work of breathing, reduce dyspnea, improve airway humidification, and potentially stabilize or reduce carbon dioxide levels. However, there is limited data showing the chronic effects of HNHF-O2 in patients with hypercapnic respiratory failure, specifically those discharged to home following hospitalization for an acute exacerbation. Data that demonstrates that HNHF-O2 is well tolerated, and stabilizes or improves gas exchange long term in patients with COPD is lacking. Similarly, data that demonstrates that this therapeutic regimen is feasible to provide to patients in the home environment are lacking. This is an open-labeled pilot study of thirty patients to determine the safety and feasibility of using the device in the outpatient management of patients with COPD. A subset of ten patients will have serial sleep studies to determine the effects, if any, on sleep.

Recruitment & Eligibility

Inclusion Criteria

admitted to the hospital for an acute exacerbation of COPD within the past 12 weeks
have COPD as the primary diagnosis
have smoked > 10 pack years.
receiving supplemental oxygen as part of their usual clinical care.
willing to give informed consent

Exclusion Criteria

upper airway or nasal problems that prohibit the use of high flow oxygen
current use (≤ 4 weeks of study entry) of any PAP-therapy (e.g., CPAP or NPPV)
sleep apnea as follows: STOPBang scores ≥ 5 or STOPBang score ≥ 2 plus BMI > 35 kg/m2; or Berlin questionnaire scores suggesting high likelihood of sleep apnea with increased risk of sleep-related accident (e.g., occupation as a commercial driver or pilot);
excessive daytime sleepiness (i.e., either of High (>15) score on the Epworth Sleepiness Scale or "fall asleep" accident or "near miss" accident in prior 12 months).

Arm && Interventions

Group	Intervention	Description
Nasal high flow with oxygen	Humidified nasal high flow with oxygen	While in the clinic High Flow Nasal Cannula oxygen will be passed through a heated humidifier (AIRVO-2, Fisher and Paykel Healthcare) and applied continuously through large-bore binasal prongs (Optiflow+ Fisher and Paykel Healthcare), with a gas flow rate of 20-35 liters per minute or as high as the patient will tolerate and an FiO2 to keep arterial oxygen saturation (SaO2) \> 90%. Temperature will be adjusted based on patient's comfort and range from 34-37 degrees based on prior experience. The subject will be discharged to home and instructed to use the high flow nasal cannula system at night and during the daytime while at home and resting.

Primary Outcome Measures

Name	Time	Method
Use of Oxygen Therapy by HNHF-O2 at Home	90 days	Number of hours of use of the device per day as recorded on the device

Secondary Outcome Measures

Name	Time	Method
Breathlessness	90 days	Borg dyspnea scale Minimum value =0; Maximum value = 10 Higher scores mean greater shortness of breath
Change in 6 Minute Walk Distance	90 days	Total distance walked in 6 minutes
Spirometry	90 days	Change in FEV1