Real-world data on home high-flow nasal cannula oxygen therapy in end-stage respiratory disease.

Abstract

High-flow nasal oxygen therapy (HFNOT) is a cornerstone treatment modality in severe acute hypoxemic respiratory failure, with benefits in improving oxygen deficit while normalizing breathing rate and having an effect on airway humidification. These physiological effects indicate a potential benefit in end-stage chronic respiratory failure. We aimed to assess the clinical impact of home HFNOT in reducing both exacerbation rates and overall disease burden in end-stage chronic respiratory disease. We designed a retrospective study including patients followed in the pulmonology department of a tertiary center who started home HFNOT until June 2023. Pre- and post-home HFNOT exacerbations and hospital admissions were registered, and each patient served as their own control for the statistical analysis. In total, 36 patients were included in the study: 24 patients (66.7%) with interstitial lung disease and 12 (33.3%) with obstructive lung disease. Overall, the median titrated fraction of inspired oxygen was significantly lower in obstructive patients; no significant differences were found between groups regarding titrated airflow. Obstructive patients had a significantly higher number of pre-treatment exacerbations and hospital stays. Both clinical subgroups presented less median overall post-treatment exacerbations and hospital admissions vs. pre-treatment start. Although mortality was high, home treatment was well tolerated by most patients, with only one patient interrupting high-flow therapy due to intolerance. Home HFNOT proved to be an overall feasible treatment strategy for patients with end-stage respiratory disease. Obstructive lung disease patients benefited the most from the treatment, possibly due to hypercapnia correction.