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. 2023 Apr 27;11(9):1250.
doi: 10.3390/healthcare11091250.

Long-Term High Flow Nasal Cannula Therapy in Primary and Secondary Bronchiectasis

Francesca Simioli  1 , Giuseppe Fiorentino  1 , Rosa Cauteruccio  1 , Antonietta Coppola  1 , Pasquale Imitazione  1 , Antonella Marotta  1 , Valentina Di Spirito  1 , Anna Annunziata  1
Affiliations

Long-Term High Flow Nasal Cannula Therapy in Primary and Secondary Bronchiectasis

Francesca Simioli et al. Healthcare (Basel). .

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.

Keywords: COPD; cystic fibrosis; heated and humidified therapy; mucus; rehabilitation.

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Conflict of interest statement

No competing interest to declare.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Exacerbations were comparable at baseline (T0) and after 2 months (T2), while reduced after the high flow therapy at 2 years (T24).
Figure 3
Figure 3
Hospitalizations were comparable at baseline (T0) and after 2 months (T2), while reduced after the high flow therapy at 2 years (T24).
Figure 4
Figure 4
Forced expiratory volume in the first second (FEV1) at baseline (T0), after 2 months (T2), and after 2 years (T24) was not significantly modified.
Figure 5
Figure 5
Forced vital capacity (FVC) at baseline (T0), after 2 months (T2), and after 2 years (T24) was not significantly modified.
Figure 6
Figure 6
Modified Medical Research Council (mMRC) scale significantly improved from baseline (T0) to follow-up after 2 months (T2) and after 2 years (T24).
Figure 7
Figure 7
Regression of exacerbations rate and temperature of high flow nasal cannula.
Figure 8
Figure 8
Regression of exacerbations rate and flow of high flow nasal cannula.
Figure 9
Figure 9
Regression of exacerbations rate and hours per day of high flow nasal cannula.
See this image and copyright information in PMC

References

    1. King P.T. The pathophysiology of bronchiectasis. Int. J. Chron. Obstruct. Pulmon. Dis. 2009;4:411–419. doi: 10.2147/COPD.S6133. - DOI - PMC - PubMed
    1. Cole P.J. Inflammation: A two-edged sword—The model of bronchiectasis. Eur. J. Respir. Dis. Suppl. 1986;147:6–15. - PubMed
    1. Wanner A., Salathe M., O’Riordan T.G. Mucociliary clearance in the airways. Am. J. Respir. Crit. Care Med. 1996;154:1868–1902. doi: 10.1164/ajrccm.154.6.8970383. - DOI - PubMed
    1. D’Cruz R.F., Hart N., Kaltsakas G. High-flow therapy: Physiological effects and clinical applications. Breathe. 2020;16:200224. doi: 10.1183/20734735.0224-2020. - DOI - PMC - PubMed
    1. Dysart K., Miller T.L., Wolfson M.R., Shaffer T.H. Research in high flow therapy: Mechanisms of action. Respir. Med. 2009;103:1400–1405. doi: 10.1016/j.rmed.2009.04.007. - DOI - PubMed