Impact of high-flow oxygen therapy during exercise in idiopathic pulmonary fibrosis: a pilot crossover clinical trial

• Published in: BMC pulmonary medicine 2021-11, Vol.21 (1), p.355-355, Article 355
• Main Authors: Badenes-Bonet, Diana, Cejudo, Pilar, Rodó-Pin, Anna, Martín-Ontiyuelo, Clara, Chalela, Roberto, Rodríguez-Portal, Jose Antonio, Vázquez-Sánchez, Rosa, Gea, Joaquim, Duran, Xavier, Caguana, Oswaldo Antonio, Rodriguez-Chiaradia, Diego Agustín, Balcells, Eva
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Care and treatment; Chronic obstructive pulmonary disease; Clinical trials; Cross-Over Studies; Dyspnea; Exercise; Exercise Test - methods; Exertional desaturation; Female; Fibrosis; High-flow nasal cannula; Humans; Idiopathic pulmonary fibrosis; Idiopathic Pulmonary Fibrosis - therapy; Lung diseases; Male; Middle Aged; Musculoskeletal system; Oxygen; Oxygen - therapeutic use; Oxygen Inhalation Therapy - methods; Oxygen Saturation; Oxygen therapy; Oxygenation; Patients; Physiological aspects; Pilot Projects; Pulmonary fibrosis; Pulmonology; Pulse oximetry; Rehabilitation; Respiration; Respiratory diseases; Testing; Ventilation
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-021-01727-9

Supplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Although high-flow nasal cannula oxygen therapy (HFNC) improves oxygenation in other respiratory diseases, its impact on exercise performance has never been evaluated in IPF patients. We hypothesized that HFNC may improve exercise capacity in IPF subjects compared to SOT. This was a prospective, crossover, pilot randomized trial that compared both oxygenation methods during a constant submaximal cardiopulmonary exercise test (CPET) in IPF patients with exertional oxygen saturation (SpO ) ≤ 85% in the 6-min walking test. The primary outcome was endurance time (Tlim). Secondary outcomes were muscle oxygen saturation (StO ) and respiratory and leg symptoms. Ten IPF patients [71.7 (6) years old, 90% males] were included. FVC and DL were 58 ± 11% and 31 ± 13% pred. respectively. Tlim during CPET was significantly greater using HFNC compared to SOT [494 ± 173 vs. 381 ± 137 s, p = 0.01]. HFNC also associated with a higher increase in inspiratory capacity (IC) [19.4 ± 14.2 vs. 7.1 ± 8.9%, respectively; p = 0.04], and a similar trend was observed in StO during exercise. No differences were found in respiratory or leg symptoms between the two oxygen devices. This is the first study demonstrating that HFNC oxygen therapy improves exercise tolerance better than SOT in IPF patients with exertional desaturation. This might be explained by changes in ventilatory mechanics and muscle oxygenation. Further and larger studies are needed to confirm the benefits of HFNC in IPF patients and its potential usefulness in rehabilitation programs.