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Jácome C, Jácome M, Correia S, Flores I, Farinha P, Duarte M, Winck JC, Sayas Catalan J, Díaz Lobato S, Luján M, Caneiras C. Effectiveness, Adherence and Safety of Home High Flow Nasal Cannula in Chronic Respiratory Disease and Respiratory Insufficiency: A Systematic Review. Arch Bronconeumol 2024:S0300-2896(24)00139-X. [PMID: 38782632 DOI: 10.1016/j.arbres.2024.05.001] [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: 02/16/2024] [Revised: 04/27/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The effectiveness of home high flow nasal cannula (HFNC) for the treatment of chronic respiratory failure in patients with chronic respiratory diseases (CRDs) has not been summarized. We aimed to conduct a systematic review of the effectiveness, adherence, and safety of HFNC in the long-term treatment of patients with chronic respiratory diseases and respiratory failure. METHODS A systematic review was conducted. PubMed, Web of science, and SCOPUS were search up to August 2023. Long-term HFNC studies (≥4 weeks) reporting dyspnea; exacerbations, hospitalizations; peripheral oxygen saturation (SpO2), comfort; patient experience, health-related quality of life or partial pressure of carbon dioxide (paCO2) were included. RESULTS Thirteen articles (701 patients) based on 10 studies were selected: randomized control trials (n=3), randomized crossover trials (n=2), crossover (n=3) and retrospective (n=2) studies. COPD (n=6), bronchiectasis (n=2), COPD/bronchiectasis (n=1) and ILD (n=1) were the underlined CRDs. HFNC reduced exacerbations when compared to usual care/home respiratory therapies (n=6). Quality of life outcomes were also in favor of HFNC in patients with COPD and bronchiectasis (n=6). HFNC had significant effects on hospitalizations, paCO2, and lung function. Adherence ranged from 5.2 to 8.6h/day (n=5). Three studies reported no events, 3 non-serious events and 2 no differences compared with other home respiratory therapies. CONCLUSIONS HFNC seems more effective than usual care or other home respiratory therapies in reducing exacerbations and improving quality of life in patients with COPD and bronchiectasis, while presenting good adherence and being safe. Its apparently superior effectiveness needs to be better studied in future real-world pragmatic trials.
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Affiliation(s)
- Cristina Jácome
- CINTESIS@RISE, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Jácome
- Unidade de Saúde Familiar Bracara Augusta, Agrupamento de Centros de Saúde (ACES) do Cávado I - Braga, Braga, Portugal
| | | | | | | | - Mónica Duarte
- Healthcare Department, Nippon Gases Portugal, Vila Franca de Xira, Portugal
| | - João Carlos Winck
- UniC, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal; Instituto CUF, Porto Portugal
| | - Javier Sayas Catalan
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Salvador Díaz Lobato
- HLA Hospital Universitario Moncloa, Universidad Europea, Nippon Gases Healthcare, Madrid, Spain
| | - Manel Luján
- Servei de Pneumologia, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Cátia Caneiras
- Microbiology Research Laboratory on Environmental Health, Institute of Environmental Health, Associate Laboratory TERRA, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal; Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Egas Moniz Interdisciplinary Research Center, Egas Moniz School of Health & Science, Monte da Caparica, Portugal; Healthcare Department, Nippon Gases Portugal, Vila Franca de Xira, Portugal.
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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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Duignan N, Ridge P, Leonard S, McDonnell M, Cusack R, Harrison M, Rutherford R, O'Malley N, Dolan C. Expanded central role of the respiratory physiotherapists in the community setting. Ir J Med Sci 2023; 192:1581-1588. [PMID: 36380190 PMCID: PMC9666941 DOI: 10.1007/s11845-022-03213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
The development of community hubs through the Slaintecare initiative will rely on respiratory physiotherapists and clinical nurse specialists for the management of chronic respiratory diseases. The role of the respiratory physiotherapist has evolved dramatically over the last decade. We review the increasing scope of practice of the physiotherapist and the evidence base for same. We pay particular attention to the role of the physiotherapist in areas such as pulmonary rehabilitation, sputum clearance, neuromuscular disease, chronic respiratory failure, ambulatory oxygen assessments and dysfunctional breathing. We give an in depth review of sputum clearance techniques. We also address areas of potential future expansion for the role of the physiotherapist such as prescription and initiation of non-invasive ventilation.
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Affiliation(s)
- Niamh Duignan
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Padraic Ridge
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland.
| | - Sinead Leonard
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Melissa McDonnell
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Ruth Cusack
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Michael Harrison
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Robert Rutherford
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Niamh O'Malley
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Ciara Dolan
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
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Simioli F, Fiorentino G, Cauteruccio R, Coppola A, Imitazione P, Marotta A, Di Spirito V, Annunziata A. Long-Term High Flow Nasal Cannula Therapy in Primary and Secondary Bronchiectasis. Healthcare (Basel) 2023; 11:healthcare11091250. [PMID: 37174791 PMCID: PMC10178516 DOI: 10.3390/healthcare11091250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Bronchiectasis is the consequence of chronic bronchial inflammation, inappropriate mucus clearance, bacterial colonization, and recurrent or chronic infection. High flow therapy (HFT) is a type of non-invasive respiratory therapy, usually delivered through a nasal cannula interface (HFNC). It delivers heated and humidified air with a stable fraction of inspired oxygen and a wide range of possible flow rates. AIM OF THE STUDY Determine the effectiveness of HFNC as add-on therapy in adult primary and secondary bronchiectasis with frequent acute exacerbations (AEs) and/or hospitalizations. METHODS This is a single-center crossover study on long-term home therapy with HFNC in adult bronchiectasis. Pharmacological therapy included pulse therapy with mucolytics and bronchodilators. After one year, all patients were switched to additional HFNC. The temperature range was 31-37 °C. The flow range was 35-60 L/m. FiO2 was 0.21. RESULTS Seventy-eight patients completed the follow-up; 54% were females; the median age was 70 years (IQR 60-76). The etiology of bronchiectasis was mainly post-infective (51%), COPD related (26%), and congenital (11%). AEs at baseline were 2.81 (±2.15). A significant reduction in AEs was observed after 24 months with a mean of 0.45 (±0.66) (f-ratio value 79.703. p-value < 0.00001). No significant difference was observed after HFNC therapy on FEV1 (2.39 ± 0.87 vs. 2.55 ± 0.82; f-ratio 0.79. p-value 0.45) and FVC (2.73 ± 0.88 vs. 2.84 ± 0.90; f-ratio 0.411. p-value 0.66). A significant reduction in mMRC score was observed after HFNC therapy (2.40 ± 0.81 vs. 0.97 ± 0.97 at 2 months vs. 0.60 ± 0.78 at 24 months; f-ratio value 95.512. p-value < 0.00001). CONCLUSIONS HFNC is a well-tolerated add-on therapy for adult bronchiectasis. Dyspnea improved after 2 months and further after 2 years. The exacerbation rate decreased during the 2 years follow-up. No significant difference was observed in lung function.
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Affiliation(s)
- Francesca Simioli
- Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, A.O. deiColli, 80131 Naples, Italy
| | - Giuseppe Fiorentino
- Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, A.O. deiColli, 80131 Naples, Italy
| | - Rosa Cauteruccio
- Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, A.O. deiColli, 80131 Naples, Italy
| | - Antonietta Coppola
- Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, A.O. deiColli, 80131 Naples, Italy
| | - Pasquale Imitazione
- Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, A.O. deiColli, 80131 Naples, Italy
| | - Antonella Marotta
- Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, A.O. deiColli, 80131 Naples, Italy
| | - Valentina Di Spirito
- Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, A.O. deiColli, 80131 Naples, Italy
| | - Anna Annunziata
- Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, A.O. deiColli, 80131 Naples, Italy
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Vega Pittao ML, Schifino G, Pisani L, Nava S. Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results. J Clin Med 2023; 12:jcm12072663. [PMID: 37048745 PMCID: PMC10094854 DOI: 10.3390/jcm12072663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
High-flow therapy (HFT) is the administration of gas flows above 15 L/min. It is a non-invasive respiratory support that delivers heated (up to 38 °C), humidified (100% Relative Humidity, RH; 44 mg H2O/L Absolute Humidity, AH), oxygen-enriched air when necessary, through a nasal cannula or a tracheostomy interface. Over the last few years, the use of HFT in critically ill hypoxemic adults has increased. Although the clinical benefit of home high-flow therapy (HHFT) remains unclear, some research findings would support the use of HHFT in chronic respiratory diseases. The aim of this review is to describe the HFT physiological principles and summarize the published clinical findings. Finally, we will discuss the differences between hospital and home implementation, as well as the various devices available for HHFT application.
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Affiliation(s)
- Maria Laura Vega Pittao
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Gioacchino Schifino
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Lara Pisani
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Nava
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
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Weinreich UM, Juhl KS, Søby Christophersen M, Gundestrup S, Hanifa MA, Jensen K, Andersen FD, Hilberg O, Storgaard LH. The Danish respiratory society guideline for long-term high flow nasal cannula treatment, with or without supplementary oxygen. Eur Clin Respir J 2023; 10:2178600. [PMID: 36861118 PMCID: PMC9970213 DOI: 10.1080/20018525.2023.2178600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Introduction Long-term High Flow Nasal Cannula (LT-HFNC), defined as High Flow Nasal Cannula treatment provided to patients with chronic pulmonary conditions during stable phases, has emerged as a home treatment in different categories of patients with chronic lung diseases in recent years. Methods This paper summarizes the physiological effects of LT-HFNC and evaluates the clinical knowledge to date about treatment in patients with chronic obstructive lung disease, interstitial lung disease and bronchiectasis. The guideline is translated and summarized in this paper and presented unabridged as an appendix to the paper. Results The paper describes the working process behind the Danish Respiratory Society's National guideline for treatment of stable disease, which has been written to support clinicians in both evidence-based decision making and practical issues concerning the treatment.
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Affiliation(s)
- Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark,The Clinical Department, Aalborg University, Aalborg, Denmark,CONTACT Ulla Møller Weinreich Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, DK-9000 Aalborg Denmark
| | - Kasper Svendsen Juhl
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Svend Gundestrup
- Department of Internal Medicine, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Munsoor Ali Hanifa
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Kristine Jensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Ole Hilberg
- Department of Medicine, Vejle Hospital, Southern Danish University Hospital, Vejle, Denmark
| | - Line Hust Storgaard
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
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Muacevic A, Adler JR, Borges J, Cardoso AL, Barbosa T. Domiciliary High-Flow Nasal Therapy in Primary Ciliary Dyskinesia. Cureus 2023; 15:e34177. [PMID: 36843741 PMCID: PMC9957583 DOI: 10.7759/cureus.34177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
We report the case of an adolescent with severe primary ciliary dyskinesia (PCD) phenotype associated with a rare genotype. His clinical condition deteriorated, with daily cough and breathlessness, hypoxemia, and lung function decline. Despite being started on home noninvasive ventilation (NIV), the symptoms progressed to dyspnea at rest and thoracic pain. High-flow nasal cannula (HFNC) was started during the daytime as an adjuvant to NIV, and he was started on regular oral opioids for pain and dyspnea control. There was a clear improvement in comfort and dyspnea and breathing work relief. Additionally, better exercise tolerance was also noted. He is currently on the lung transplant waiting list. We aim to emphasize the benefits of HFNC as an add-on therapy for the management of chronic breathlessness since our patient experienced an improvement in breathing and exercise tolerance. However, there is a paucity of studies regarding domiciliary HFNC, particularly in pediatric age. Therefore, further studies are needed to achieve optimal and personalized care. Close monitoring and frequent reassessment in a specialized center are key to adequate management.
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Long-Term Domiciliary High-Flow Nasal Therapy in Patients with Bronchiectasis: A Preliminary Retrospective Observational Case-Control Study. J Clin Med 2022; 11:jcm11247323. [PMID: 36555939 PMCID: PMC9782624 DOI: 10.3390/jcm11247323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
High-flow nasal therapy (HFNT) provides several pathophysiological benefits in chronic respiratory disorders. We aimed to evaluate the effectiveness of long-term HFNT in patients with bronchiectasis (BE). METHODS This is a retrospective bicentric case-control study of outpatients with BE on optimized medical treatment with a severe exacerbation requiring hospitalization in the previous year. Patients on long-term home HFNT (cases) and patients on optimized medical treatment alone (controls) were matched by age, sex, bronchiectasis severity index, and exacerbations in the previous year. Data on BE exacerbations, hospitalizations/year, mucus features, respiratory symptoms, and pulmonary function were collected. The primary outcome was the change from baseline in the exacerbation rates at 12 months between groups. RESULTS 20 patients in the HFNT group and 20 controls were included. A significant reduction in exacerbations [-1.9 (-2.8 to -0.9), p = 0.0005] and hospitalizations [-0.7 (-1.1 to -0.3), p = 0.0006] was found in the HFNT group vs controls. A slight improvement in pulmonary function [FEV1% +6,1% (+1% to +11.3%) (p = 0.0219), FVC% +4.6% (+0.8% to +8.3%) (p = 0.0188) and FEF25-75% +13.4 (+11 to +15.9) (p = 0.0189) was also found in the HFNT group compared to controls. CONCLUSIONS In this preliminary study, long-term domiciliary HFNT improved the clinical course of patients with BE.
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Impellizzeri P, Nolasco S, Campisi R, Cipolla A, Borgese A, Alia S, Crimi N, Crimi C. Acute and long-term management of severe bronchiectasis with high flow nasal therapy: A case report. Monaldi Arch Chest Dis 2022; 93. [PMID: 35929643 DOI: 10.4081/monaldi.2022.2333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
Bronchiectasis (BE) is a long-term, chronic lung condition featured by widened and scarred airways. These can alter the physiological mucociliary clearance, making it difficult to clear mucus and microorganisms, leading to frequent exacerbations. High flow nasal therapy (HFNT) is a noninvasive respiratory support that delivers heated and humidified gas eventually enriched with oxygen, through a nasal cannula. Humidification is crucial for adequate airways mucociliary clearance, improving ciliary function and consequently reducing airways inflammation and recurrent infections. HFNT has been mostly used in patients with acute hypoxemic respiratory failure and in selected patients with chronic respiratory failure due to COPD. Still, evidence about its use in acute and long-term home setting in patients with clinically relevant BE are lacking. We report a case of severe widespread BE, already on top medical therapy and pulmonary rehabilitation, still suffering from difficult mucus expectoration and recurrent exacerbations, who has been additionally treated with HFNT, both in hospital and domiciliary, reporting significant improvements on relevant clinical and patient-centered outcomes. Thus, HFNT may confer additional benefits as an add-on treatment of patients with severe BE and respiratory failure.
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Affiliation(s)
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Raffaele Campisi
- Respiratory Medicine Unit, Policlinico "G. Rodolico - San Marco" University Hospital, Catania.
| | - Antonino Cipolla
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Alba Borgese
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Stefano Alia
- Respiratory Medicine Unit, Policlinico "G. Rodolico - San Marco" University Hospital, Catania, Italy.
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico - San Marco" University Hospital, Catania.
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Milne RJ, Hockey HU, Garrett J. Hospital Cost Savings for Sequential COPD Patients Receiving Domiciliary Nasal High Flow Therapy. Int J Chron Obstruct Pulmon Dis 2022; 17:1311-1322. [PMID: 35686212 PMCID: PMC9173724 DOI: 10.2147/copd.s350267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To estimate the 5-year budget impact to Aotearoa New Zealand (NZ) hospitals of domiciliary nasal high flow (NHF) therapy to patients with chronic obstructive pulmonary disease (COPD) who require long term oxygen therapy. Methods Hospital admission counts along with length of stay were obtained from hospital records of 200 COPD patients enrolled in a 12-month randomized clinical trial of NHF in Denmark, both over a 12-month baseline and then in the study period while on randomized treatment (control or NHF). NZ costings from similar COPD patients were estimated using data from Middlemore Hospital, Auckland and were applied to the Danish trial. The budget impact of NHF was estimated over the predicted 5-year lifetime of the device when used by patients sequentially. Results Fifty-five of 100 patients in the NHF group and 44 of 100 patients in the control group were admitted to hospital with a respiratory diagnosis during the baseline year. They had 108 admissions in the treatment group vs 89 in the control group, with 632 vs 438 days in hospital, and modeled annual costs of $9443 vs $6512 per patient, respectively. During the study period there were 38 vs 44 patients with 67 vs 80 admissions and 302 vs 526 days in hospital, at a modeled annual cost of $6961 vs $9565 per patient respectively. Taking into account capital expenditure and running costs, this resulted in cost savings of $5535 per patient-year (95% CI, -$36 to -$11,034). With 90% usage over the estimated five-year lifetime of the NHF device, amortized capital costs of $594 per year and annual running costs of $662, we estimate a 5-year undiscounted cost saving per NHF device of $18,626 ($16,934 when discounted to net present value at 5% per annum). There would still be annual cost savings over a wide range of assumptions. Conclusion Domiciliary NHF therapy for patients with severe COPD has the potential to provide substantial hospital cost savings over the five-year lifetime of the NHF device.
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Affiliation(s)
- Richard J Milne
- Health Outcomes Associates Ltd, Auckland, New Zealand
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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Weinreich UM, Burchardt C, Huremovic J. The effect of domiciliary high flow nasal cannula treatment on dyspnea and walking distance in patients with interstitial lung disease - A pilot study. Chron Respir Dis 2022; 19:14799731221137085. [PMID: 36366859 PMCID: PMC9661555 DOI: 10.1177/14799731221137085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Interstitial Lung Diseases (ILD) affect the lung parenchyma and are often complicated by respiratory failure (RF) and impaired physical activity. High Flow Nasal Cannula (HFNC) has proved effective in other disease entities with RF. The aim of this study is to investigate the effect of domiciliary HFNC in ILD on dyspnea and walking distance. METHODS A 6 weeks cross-over study with domiciliary HFNC-treatment/6 weeks' observation in ILD-patients requiring ambulatory oxygen therapy or with newly prescribed (within 12 months) long term oxygen therapy. Patients were advised to use HFNC 8 h/day, recommended night-time use. Body phletysmography; 6-min walk test (6MWT) including BORG-score, oxygen saturation (SO2) at start, minimum SO2 and time to recovery after 6MWT; arterial blood gasses; modified Medical Research Council (mMRC)-score; quality of life, by the St George Respiratory Questionnaire (SGRQ) and QoS, by the Richards-Campbell Sleep Questionnaire (RCSQ) were investigated at baseline; six weeks and 12 weeks. RESULTS 10 patients were included; one later withdrew consent. Patients used HFNC between 8-<1 h/day. There were no differences in lung function; blood gasses; SGRQ or RCSQ over the observational period). Walking distance improved significantly (393-441 m p = 0.049) as did time to recovery (3.4-2-2 min, p = 0.001). When correcting for HFNC use (hours/day) significant improvement was also seen in mMRC-score (p = 0.035) and minimum saturation during 6MWT (p = 0.01). CONCLUSION Despite a very heterogenous group and no effect on quality of life and -sleep, the study indicates an improvement in dyspnea and physical ability of HFNC in ILD patients.
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Affiliation(s)
- Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- The Clinical Department, Aalborg University, Aalborg, Denmark
| | - Charlotte Burchardt
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Jasmina Huremovic
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
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