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Tomii K. An additional mechanism enhancing exercise tolerance in interstitial lung disease with high-flow nasal cannula. Respirology 2024; 29:445-446. [PMID: 38527948 DOI: 10.1111/resp.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
See related article
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Affiliation(s)
- Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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Candia C, Lombardi C, Merola C, Ambrosino P, D’Anna SE, Vicario A, De Marco S, Molino A, Maniscalco M. The Role of High-Flow Nasal Cannula Oxygen Therapy in Exercise Testing and Pulmonary Rehabilitation: A Review of the Current Literature. J Clin Med 2023; 13:232. [PMID: 38202239 PMCID: PMC10779451 DOI: 10.3390/jcm13010232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
High-flow nasal cannula (HFNC) has recently emerged as a crucial therapeutic strategy for hypoxemic patients both in acute and chronic settings. Indeed, HFNC therapy is able to deliver higher fractions of inspired oxygen (FiO2) with a heated and humidified gas flow ranging from 20 up to 60 L per minute, in a more comfortable way for the patient in comparison with Conventional Oxygen Therapy (COT). In fact, the flow keeps the epithelium of the airways adequately moisturized, thus positively affecting the mucus clearance. Finally, the flow is able to wash out the carbon dioxide in the dead space of the airways; this is also enhanced by a modest positive end-expiratory pressure (PEEP) effect. Recent evidence has shown applications of HFNC in exercise training and chronic settings with promising results. In this narrative review, we explored how HFNC might contribute to enhancing outcomes of exercise training and pulmonary rehabilitation among patients dealing with chronic obstructive pulmonary disease, interstitial lung diseases, and lung cancer.
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Affiliation(s)
- Claudio Candia
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (A.V.); (A.M.)
| | - Carmen Lombardi
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (C.L.); (C.M.); (S.E.D.)
| | - Claudia Merola
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (C.L.); (C.M.); (S.E.D.)
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Silvestro Ennio D’Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (C.L.); (C.M.); (S.E.D.)
| | - Aldo Vicario
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (A.V.); (A.M.)
| | - Stefania De Marco
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (A.V.); (A.M.)
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (A.V.); (A.M.)
| | - Mauro Maniscalco
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (A.V.); (A.M.)
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (C.L.); (C.M.); (S.E.D.)
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Contreras-Briceño F, Espinosa-Ramírez M, Rivera-Greene A, Guerra-Venegas C, Lungenstrass-Poulsen A, Villagra-Reyes V, Caulier-Cisterna R, Araneda OF, Viscor G. Monitoring Changes in Oxygen Muscle during Exercise with High-Flow Nasal Cannula Using Wearable NIRS Biosensors. BIOSENSORS 2023; 13:985. [PMID: 37998160 PMCID: PMC10669262 DOI: 10.3390/bios13110985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
Exercise increases the cost of breathing (COB) due to increased lung ventilation (V˙E), inducing respiratory muscles deoxygenation (∇SmO2), while the increase in workload implies ∇SmO2 in locomotor muscles. This phenomenon has been proposed as a leading cause of exercise intolerance, especially in clinical contexts. The use of high-flow nasal cannula (HFNC) during exercise routines in rehabilitation programs has gained significant interest because it is proposed as a therapeutic intervention for reducing symptoms associated with exercise intolerance, such as fatigue and dyspnea, assuming that HFNC could reduce exercise-induced ∇SmO2. SmO2 can be detected using optical wearable devices provided by near-infrared spectroscopy (NIRS) technology, which measures the changes in the amount of oxygen bound to chromophores (e.g., hemoglobin, myoglobin, cytochrome oxidase) at the target tissue level. We tested in a study with a cross-over design whether the muscular desaturation of m.vastus lateralis and m.intercostales during a high-intensity constant-load exercise can be reduced when it was supported with HFNC in non-physically active adults. Eighteen participants (nine women; age: 22 ± 2 years, weight: 65.1 ± 11.2 kg, height: 173.0 ± 5.8 cm, BMI: 21.6 ± 2.8 kg·m-2) were evaluated in a cycle ergometer (15 min, 70% maximum watts achieved in ergospirometry (V˙O2-peak)) breathing spontaneously (control, CTRL) or with HFNC support (HFNC; 50 L·min-1, fiO2: 21%, 30 °C), separated by seven days in randomized order. Two-way ANOVA tests analyzed the ∇SmO2 (m.intercostales and m.vastus lateralis), and changes in V˙E and ∇SmO2·V˙E-1. Dyspnea, leg fatigue, and effort level (RPE) were compared between trials by the Wilcoxon matched-paired signed rank test. We found that the interaction of factors (trial × exercise-time) was significant in ∇SmO2-m.intercostales, V˙E, and (∇SmO2-m.intercostales)/V˙E (p < 0.05, all) but not in ∇SmO2-m.vastus lateralis. ∇SmO2-m.intercostales was more pronounced in CTRL during exercise since 5' (p < 0.05). Hyperventilation was higher in CTRL since 10' (p < 0.05). The ∇SmO2·V˙E-1 decreased during exercise, being lowest in CTRL since 5'. Lower dyspnea was reported in HFNC, with no differences in leg fatigue and RPE. We concluded that wearable optical biosensors documented the beneficial effect of HFNC in COB due to lower respiratory ∇SmO2 induced by exercise. We suggest incorporating NIRS devices in rehabilitation programs to monitor physiological changes that can support the clinical impact of the therapeutic intervention implemented.
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Affiliation(s)
- Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
- Millennium Institute for Intelligent Healthcare Engineering (iHEALTH), Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Maximiliano Espinosa-Ramírez
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Augusta Rivera-Greene
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Camila Guerra-Venegas
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Antonia Lungenstrass-Poulsen
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Victoria Villagra-Reyes
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Raúl Caulier-Cisterna
- Department of Informatics and Computing, Faculty of Engineering, Universidad Tecnológica Metropolitana, Av. José Pedro Alessandri #1242, Santiago 7800002, Chile;
| | - Oscar F. Araneda
- Laboratory of Integrative Physiology of Biomechanics and Physiology of Effort, Kinesiology School, Faculty of Medicine, Universidad de los Andes, Av. Monseñor Álvaro del Portillo 12455, Santiago 7620001, Chile;
| | - Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal #643, 08028 Barcelona, Spain;
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Yang H, Huang D, Luo J, Liang Z, Li J. The use of high-flow nasal cannula in patients with chronic obstructive pulmonary disease under exacerbation and stable phases: A systematic review and meta-analysis. Heart Lung 2023; 60:116-126. [PMID: 36965283 DOI: 10.1016/j.hrtlng.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/04/2023] [Accepted: 02/19/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) has been increasingly utilized in patients with chronic obstructive pulmonary disease (COPD); however, the effects on reducing the need for intubation or reintubation remain unclear. OBJECTIVES We aimed to investigate whether HFNC therapy was superior to conventional oxygen therapy (COT) or noninvasive ventilation (NIV) in patients with COPD. METHODS A literature search was performed in electronic databases until October 1st, 2022. The primary outcome was the need for intubation/reintubation. All analyses were performed using R (version 4.0.3) and STATA SE (version 15.1). RESULTS When HFNC therapy was compared with NIV in patients with COPD under initial respiratory support and postextubation, no significant differences were found in the risk of intubation (RR 0.84, 95% CI 0.36 to 1.98) and reintubation (RR 1.35, 95% CI 0.73 to 2.50). Compared to NIV, HFNC therapy did not decrease the partial pressure of carbon dioxide or increase the partial pressure of oxygen to the fraction of inspired oxygen. However, HFNC therapy was associated with a lower incidence of skin breakdown (RR 0.52, 95% CI 0.39 to 0.69) and a higher comfort score (SMD 0.90, 95% CI 0.60 to 1.20) than NIV. When HFNC therapy was compared with COT during initial respiratory treatment for COPD exacerbation, a lower risk of treatment failure was found (RR 0.58, 95% CI 0.37 to 0.89). When HFNC therapy was compared with long-term oxygen therapy, quality of life (measured by SGRQ-C) was significantly improved (SMD -0.42, 95% CI -0.69 to -0.14). CONCLUSION HFNC therapy might be used as an alternative to NIV for COPD exacerbation with mild-moderate hypercapnia under close monitoring and is a potential domiciliary treatment for stable COPD.
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Affiliation(s)
- Huan Yang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, China
| | - Jian Luo
- Respiratory Medicine Unit and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, China.
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, 60612, USA.
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Ahn Y, Lee HS, Lee SH, Joa KL, Lim CY, Ahn YJ, Suh HJ, Park SS, Hong KB. Effects of gypenoside L-containing Gynostemma pentaphyllum extract on fatigue and physical performance: A double-blind, placebo-controlled, randomized trial. Phytother Res 2023. [PMID: 36877124 DOI: 10.1002/ptr.7801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
This study was conducted to investigate the effect of Gynostemma pentaphyllum extract containing gypenoside L (GPE) on improving the cognitive aspects of fatigue and performance of the motor system. One hundred healthy Korean adults aged 19-60 years were randomized to the treatment (GPE for 12 weeks) and control groups, and efficacy and safety-related parameters were compared between the two groups. Maximal oxygen consumption (VO2 max) and O2 pulse were significantly higher in the treatment group than in the control group (p = 0.007 and p = 0.047, respectively). After 12 weeks, the treatment group showed significant changes such as decreases in the levels of free fatty acids (p = 0.042). In addition, there were significant differences in the rating of perceived exertion (RPE) (p < 0.05) and value of temporal fatigue between the treatment and control groups on the multidimensional fatigue scale (p < 0.05). Moreover, the level of endothelial nitric oxide synthase (eNOS) in the blood was significantly higher in the treatment group than in the control group (p = 0.047). In summary, oral administration of GPE has a positive effect on resistance to exercise-induced physical and mental fatigue.
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Affiliation(s)
- Yejin Ahn
- Department of Integrated Biomedical and Life Science, Graduate School, Korea University, Seoul, South Korea
| | - Hee-Seok Lee
- Department of Food Science and Technology, Chung-Ang University, Anseong, South Korea
| | - Seok-Hee Lee
- Department of Food Science and Biotechnology, Dongguk University, Goyang, South Korea
| | - Kyung-Lim Joa
- Department of Physical & Rehabilitation Medicine, College of Medicine, Inha University School of Medicine, Incheon, South Korea
| | | | - Yu Jin Ahn
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Hyung Joo Suh
- Department of Integrated Biomedical and Life Science, Graduate School, Korea University, Seoul, South Korea.,BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
| | - Sung-Soo Park
- Department of Food Science and Nutrition, Jeju National University, Jeju, South Korea
| | - Ki-Bae Hong
- Department of Food Science and Nutrition, Jeju National University, Jeju, South Korea
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Vera Cruz de Oliveira Castellano1 M, Fernando Ferreira Pereira2 L, Henrique Ramos Feitosa3 P, Maria Knorst4,5 M, Salim6,7 C, Monteiro Rodrigues1 M, Vieira Machado Ferreira8 E, Luiz de Menezes Duarte9 R, Maria Togeiro10 S, Zanol Lorencini Stanzani3 L, Medeiros Júnior6 P, Nadaf de Melo Schelini11 K, Sousa Coelho12 L, Lins Fagundes de Sousa13 T, Buarque de Almeida14 M, Eduardo Alvarez15 A. 2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy. J Bras Pneumol 2022; 48:e20220179. [DOI: 10.36416/1806-3756/e20220179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations. LTOT is indicated in other respiratory diseases that cause hypoxemia, on the basis of the same criteria as those used for COPD. There has been an increase in the use of LTOT, probably because of increased life expectancy and a higher prevalence of chronic respiratory diseases, as well as greater availability of LTOT in the health care system. The first Brazilian Thoracic Association consensus statement on LTOT was published in 2000. Twenty-two years la-ter, we present this updated version. This document is a nonsystematic review of the literature, conducted by pulmonologists who evaluated scientific evidence and international guidelines on LTOT in the various diseases that cause hypoxemia and in specific situations (i.e., exercise, sleep, and air travel). These recommendations, produced with a view to clinical practice, contain several charts with information on indications for LTOT, oxygen sources, accessories, strategies for improved efficiency and effectiveness, and recommendations for the safe use of LTOT, as well as a LTOT prescribing model.
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Affiliation(s)
| | | | | | - Marli Maria Knorst4,5
- 4. Faculdade de Medicina, Universidade Federal do Rio Grande do Sul –UFRGS – Porto Alegre (RS) Brasil. 5. Hospital de Clínicas de Porto Alegre – HCPA – Porto Alegre (RS) Brasil
| | - Carolina Salim6,7
- 6. AC Camargo Cancer Center, São Paulo (SP) Brasil. 7. Hospital da Polícia Militar de São Paulo, São Paulo (SP) Brasil
| | | | | | | | - Sonia Maria Togeiro10
- 10. Disciplina de Clínica Médica e Medicina Laboratorial, Universidade Federal de São Paulo – Unifesp – São Paulo (SP), Brasil
| | | | | | | | - Liana Sousa Coelho12
- 12. Universidade Estadual Julio de Mesquita Filho – UNESP – Botucatu (SP) Brasil
| | - Thiago Lins Fagundes de Sousa13
- 13. Hospital Universitário Alcides Carneiro, Universidade Federal de Campina Grande – HUAC/UFCG – Campina Grande (PB) Brasil
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Efficacy of Nasal High-Flow Oxygen Therapy in Chronic Obstructive Pulmonary Disease Patients in Long-Term Oxygen and Nocturnal Non-Invasive Ventilation during Exercise Training. Healthcare (Basel) 2022; 10:healthcare10102001. [PMID: 36292448 PMCID: PMC9601581 DOI: 10.3390/healthcare10102001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022] Open
Abstract
High-flow oxygen therapy (HFOT) improves gas exchange and dead space washout and reduces the level of work required for breathing. This study aimed to evaluate pulmonary rehabilitation (PR) combined with HFOT in COPD patients treated with nocturnal non-invasive ventilation (NIV) and long-term oxygen therapy (LTOT). In particular, we sought to discover whether the addition of HFOT during exercise training could improve patients’ performance, mainly with regard to their Six-Minute Walking Test (6MWT) outcomes, and reduce the exacerbation rates, periods of rehospitalization or need to resort to unscheduled visits. Thirty-one COPD subjects (13 female) who used nocturnal NIV were included in a randomized controlled trial and allocated to one of two groups: the experimental group (EG), with 15 subjects, subjected to PR with HFOT; and the control group (CG), with 16 subjects, subjected to PR without HFOT. The primary outcome of the study was the observation of changes in the 6MWT. The secondary outcome of the study was related to the rate of exacerbation and hospitalization. Data were collected at baseline and after one, two and three cycles of cycle-ergometer exercise training performed in 20 supervised sessions of 40 min thrice per week, with a washout period of 3 months between each rehabilitation cycle. Statistical significance was not found for the 6MWT distance (W = 0.974; p = 0.672) at the last follow-up, but statistical significance was found for the Borg scale in regard to dyspnea (W = 2.50; p < 0.001) and fatigue (W = 2.00; p < 0.001). HFOT may offer a positive option for dyspnea-affected COPD patients in the context of LTOT and nocturnal NIV.
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Chihara Y, Tsuboi T, Sumi K, Sato A. Effectiveness of high-flow nasal cannula on pulmonary rehabilitation in subjects with chronic respiratory failure. Respir Investig 2022; 60:658-666. [PMID: 35644803 DOI: 10.1016/j.resinv.2022.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/03/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The effects of exercise training using both high fraction of inspired oxygen (FIO2) and high flow oxygen delivered through a high-flow nasal cannula (HFNC) on exercise capacity in patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) are unknown. METHODS In this randomized study, 32 patients with CRF receiving LTOT were assigned to undergo 4 weeks of exercise training on a cycle ergometer using an HFNC (flow: 50 L/min) with a FIO2 of 1.0 (HFNC group; n = 16) or ordinary supplemental oxygen via a nasal cannula (flow: 6 L/min) (oxygen group; n = 16). A 6-min walking test and a constant-load test were performed before and after 4 weeks of exercise training. RESULTS Following 4 weeks of exercise training, change in the 6-min walking distance was significantly greater in the HFNC than in the oxygen group (55.2 ± 69.6 m vs. -0.5 ± 87.3 m; p = 0.04). However, there was no significant difference between the two groups in the degree of improvement in the duration of the constant-load exercise test after exercise training. CONCLUSIONS Considering the effect on daily activities (e.g., walking), exercise training using both high FIO2 and high flow through an HFNC is a potentially superior exercise training modality for patients with CRF receiving LTOT. Clinical Trial Registration - http://www. CLINICALTRIALS gov. Unique identifier: NCT02804243.
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Affiliation(s)
- Yuichi Chihara
- Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Kyoto, Japan.
| | - Tomomasa Tsuboi
- Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Kyoto, Japan
| | - Kensuke Sumi
- Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Kyoto, Japan
| | - Atsuo Sato
- Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Kyoto, Japan
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Nasal High-Flow during Exercise in Patients with COPD: A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2021; 19:291-302. [PMID: 34644515 DOI: 10.1513/annalsats.202104-436sr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale Several studies have evaluated the effect of nasal high flow (NHF) to enhance exercise performance and tolerance in patients with COPD, however results are disparate. Objective The aim of this systematic review and meta-analysis was to assess the effect of NHF as an adjuvant to exercise training on functional exercise capacity in patients with COPD. Method An electronic search was carried out in the following databases: Pubmed, CENTRAL, PEDro, ScienceDirect, Web of Science, OpenGrey, ClinicalTrials.gov, European Respiratory Society and American Thoracic Society databases. Two authors independently selected relevant randomized trials (parallel group or cross-over design), extracted data, assessed the risk of bias and rated the quality of the evidence. Results Eleven studies were included, involving 408 participants (8 full papers and 3 conference abstracts). Most studies had a high risk of bias or other methodological limitations. The use of NHF during a single session increased functional exercise capacity (SMD 0.36 (95% CI 0.03 to 0.69) p=0.03, heterogeneity (I² 83 %)). When conference abstracts were included in the pooled analysis, the estimated effect did not change (p=0.006). The use of NHF throughout a pulmonary rehabilitation programme (parallel group RCTs) increased functional exercise capacity at 4 to 12 weeks compared with those who trained without NHF (SMD 0.34 (95% CI 0.00 to 0.68) p=0.05, heterogeneity (I² 18%)). Conclusion There is very low to low quality evidence that NHF improves functional exercise capacity. Patient responses to NHF therapy were highly variable and heterogeneous, with benefits ranging from clinically trivial to worthwhile. Registration (www.crd.york.ac.uk/prospero: CRD42021221550).
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Xiang G, Zhu X, Ma L, Huang H, Wu X, Zhang W, Li S. Clinical guidelines on the application of Internet of Things (IOT) medical technology in the rehabilitation of chronic obstructive pulmonary disease. J Thorac Dis 2021; 13:4629-4637. [PMID: 34527304 PMCID: PMC8411163 DOI: 10.21037/jtd-21-670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Guiling Xiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodan Zhu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Ma
- Department of Pulmonary Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huai Huang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodan Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Zhang
- Department of Pulmonary Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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The effect of heated humidified nasal high flow oxygen supply on exercise tolerance in patients with interstitial lung disease: A pilot study. Respir Med 2021; 186:106523. [PMID: 34225230 DOI: 10.1016/j.rmed.2021.106523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/01/2021] [Accepted: 06/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with interstitial lung disease (ILD) experience early symptoms of dyspnoea and leg fatigue during exercise together with severe and rapid oxygen desaturation. Heated and humidified nasal high flow oxygen (NHF) has been proven to enhance exercise endurance and physiological parameters in COPD patients. This study aims to evaluate the effect of NHF on exercise tolerance in ILD patients. METHODS Twenty-five patients (10 female) with severe ILD performed three constant-load (70% maximal workload) cycling tests to exhaustion under different breathing conditions: room air, oxygen supplementation (4 L min-1 O2) and NHF (inspiratory O2 fraction 0.5, 30-50 L min-1, heated 34 °C and humidified). RESULTS Endurance time was significantly longer with NHF (618 ± 297 s) compared to O2 (369 ± 217 s, p < 0.001) and room air (171 ± 76 s, p < 0.001). Kinetics of oxygen desaturation, chronotropic response, dyspnoea and leg fatigue sensations were delayed with NHF. At exhaustion with NHF, compared to the two other conditions, oxygen desaturation was less severe while heart rate, dyspnoea and leg fatigue were similar. CONCLUSION NHF significantly improved endurance time, physiological parameters and sensations during exercise in severe ILD patients. NHF may be useful to improve functional capacities and facilitate pulmonary rehabilitation in ILD.
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Bitos K, Furian M, Mayer L, Schneider SR, Buenzli S, Mademilov MZ, Sheraliev UU, Marazhapov NH, Abdraeva AK, Aidaralieva SD, Muratbekova AM, Sooronbaev TM, Ulrich S, Bloch KE. Effect of High-Flow Oxygen on Exercise Performance in COPD Patients. Randomized Trial. Front Med (Lausanne) 2021; 7:595450. [PMID: 33693009 PMCID: PMC7938234 DOI: 10.3389/fmed.2020.595450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background: High-flow oxygen therapy (HFOT) provides oxygen-enriched, humidified, and heated air at high flow rates via nasal cannula. It could be an alternative to low-flow oxygen therapy (LFOT) which is commonly used by patients with chronic obstructive pulmonary disease (COPD) during exercise training. Research Question: We evaluated the hypothesis that HFOT improves exercise endurance in COPD patients compared to LFOT. Methods: Patients with stable COPD, FEV1 40–80% predicted, resting pulse oximetry (SpO2) ≥92%, performed two constant-load cycling exercise tests to exhaustion at 75% of maximal work rate on two different days, using LFOT (3 L/min) and HFOT (60 L/min, FiO2 0.45) in randomized order according to a crossover design. Primary outcome was exercise endurance time, further outcomes were SpO2, breath rate and dyspnea. Results: In 79 randomized patients, mean ± SD age 58 ± 9 y, FEV1 63 ± 9% predicted, GOLD grades 2-3, resting PaO2 9.4 ± 1.0 kPa, intention-to-treat analysis revealed an endurance time of 688 ± 463 s with LFOT and 773 ± 471 s with HFOT, mean difference 85 s (95% CI: 7 to 164, P = 0.034), relative increase of 13% (95% CI: 1 to 28). At isotime, patients had lower respiratory rate and higher SpO2 with HFOT. At end-exercise, SpO2 was higher by 2% (95% CI: 2 to 2), and Borg CR10 dyspnea scores were lower by 0.8 points (95% CI: 0.3 to 1.2) compared to LFOT. Interpretation: In mildly hypoxemic patients with COPD, HFOT improved endurance time in association with higher arterial oxygen saturation, reduced respiratory rate and less dyspnea compared to LFOT. Therefore, HFOT is promising for enhancing exercise performance in COPD. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03955770.
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Affiliation(s)
- Konstantinos Bitos
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Michael Furian
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Laura Mayer
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Simon R Schneider
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Simone Buenzli
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Maamed Z Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Ulan U Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Nuridin H Marazhapov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Ainura K Abdraeva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Shoira D Aidaralieva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Aybermet M Muratbekova
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Talant M Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Silvia Ulrich
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
| | - Konrad E Bloch
- Department of Respiratory Medicine and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Bishkek, Kyrgyzstan
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