Does home high flow nasal therapy improve patient outcomes in chronic hypercapnic respiratory failure in COPD and OHS?

Treatment concordance with domiciliary NIV (D-NIV) can be low with 53% adherent at one year post treatment initiation in one study (1). This is concerning since adherence with treatment can improve hypercapnia, and health-related quality of life (HRQOL). Some guidance suggests high flow nasal therapy (HFNT) can be considered in chronic obstructive pulmonary disease (COPD) (2), when users cannot tolerate D-NIV. No evidence exists for its use in increasingly prevalent obesity hypoventilation syndrome (OHS). This pre-post intervention study investigated if HFNT improved HRQOL in individuals with OHS or COPD, unable to use D-NIV. 27 participants used home HFNT for twelve weeks. HFNT was used for 56% of nights, with 32% usage > 4 hours. There were significant improvements in HRQOL (measured by the Severe Respiratory Insufficiency Index), subjective breathlessness, exercise capacity and physiological outcomes (Table 1). erjor;12/suppl_17/140/TB1 T1 TB1 Table 1: Patient-reported and physiological outcomes with home HFNT Variable Baseline Week 12 p-value Severe respiratory insufficiency index summary scale 60.8 (19.1) 74.5 (13.9)