Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Investigating the Effect of Nasal High Flow Oxygen Therapy on Regional Lung Function
This study aims to assess the effect of nasal high flow oxygen therapy on regional function measured by volumetric computed tomography, in patients with chronic obstructive pulmonary disease.
Nasal high flow (NHF) is a non-invasive breathing therapy that is based on the delivery of
heated and humidified air at flow rates that exceed peak inspiratory flow, via a
large-caliber nasal cannula. It delivers a fraction of inspired oxygen (FiO2) from 21% to
100%, with a flow rate up to 60 L·min−1.
The therapy is used for a variety of disease conditions including chronic obstructive
pulmonary disease (COPD). Patients with COPD frequently manifest flow limitation during
resting tidal breathing, through dynamic compression of the airways, which is attributed to a
loss of parenchymal tethering of the airways. In patients with severe COPD and respiratory
failure, improved oxygenation and ventilation may reduce mortality. There are limited
clinical data available in adult applications of NHF and on the effectiveness of NHF in
patients with stable moderate or severe COPD.
The mechanisms through which NHF affects the respiratory system are still being investigated.
Two of the proposed mechanisms of action of NHF therapy are the generation of 3-5 cmH20
positive airway pressure during expiration and washout of the nasopharyngeal dead space.
Positive airway pressure has been shown to improve oxygenation, ventilation-perfusion
matching and respiratory rates, while nasopharyngeal washout reduces the anatomical dead
space and thereby improves alveolar ventilation.
Our working hypothesis is that positive nasopharyngeal pressure generated by NHF particularly
during expiration can help maintain small peripheral airways patent, thereby reducing the
amount of gas trapping.
Gas trapping can be quantified based on densitometric analysis of registered computerized
tomography images obtained at high and low lung volumes.
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