P8. Humidification therapy

In 2016, two trials reported on the physiological benefits of nasal high flow humidified air (NHF) in COPD patients.  In a small trial involving 6 non-hypoxic COPD patients, Biselli et al found that nocturnal NHF significantly decreased the work of breathing and improved transcutaneous carbon dioxide levels, whereas oxygen produced only a minimal reduction in the work of breathing and increased carbon dioxide levels (Biselli 2017).   Fraser et al compared the effects of 20 minutes of NHF (with oxygen) to standard supplemental nasal oxygen in 30 male oxygen dependent COPD patients (Fraser 2016).   Fraser et al also found that NHF reduced transcutaneous CO2 and respiratory rate and increased tidal volume.  Of note, the patients reported that the standard nasal oxygen interface provided more dyspnea relief and was more comfortable.

A randomised trial by Rea et al (Rea 2010) found that NHF for up to 2 hours daily reduced annual exacerbation days and days to first exacerbation but not hospital admission compared with usual care in a group of 108 patients, with COPD/bronchiectasis. Quality of life and lung function also improved. No sham treatment was given. No cost evaluation data were provided in this study.   Prospective randomised controlled trials in the appropriate COPD patient population with meaningful clinical endpoints are required before long term domiciliary NHF can be recommended. In the acute setting, high flow nasal oxygen has a role in hypoxic respiratory failure where hypercapnia has been excluded (Stephan 2015, Frat 2015).