high-flow in hypercapnic stable copd patients

Conditions: Adherence, Treatment

Summary: monocentric, prospective, open, randomized 1:1, controlled study to evaluate the impact of nasal high-flow (nhf) on nocturnal transcutaneous pco2 (ptco2) compared to non-invasive ventilation ± long-term oxygen therapy (ltot) in patients with a chronic obstructive pulmonary disease (copd)-related hypercapnic respiratory failure.

chronic obstructive pulmonary disease (copd) is a growing global health concern, causing considerable health-related costs and increased mortality. copd is nowadays considered a complex, heterogeneous and systemic condition. in the late stage of the disease, non-invasive ventilation (niv) is widely prescribed either to treat acute hypercapnic respiratory failure during copd exacerbations or for long term home management. a meta-analysis has shown that higher daytime paco2 occurred in home niv treated copd patients when niv compliance is less than 5 h/day. thus, an optimal niv adherence is a key target for controlling nocturnal and diurnal hypoventilation and improving prognosis. copd is the clinical scenario during which a good niv adherence is difficult to achieve. particularly, in copds exhibiting hyperinflation, niv can aggravate dynamic hyperinflation resulting in unrewarded inspiratory efforts, poor sleep and low niv compliance. alternatives to niv are then desirable in this specific subgroup of hypercapnic copd with poor adherence to niv. during this trial, stable copd patients treated by long term home non-invasive ventilation (niv) treatment following french national recommendations and exhibiting a niv compliance of (less than 5 hours and more than 1 hour) per day in the last 3 months prior to inclusion will be randomized via a secure electronic website to either continue with their current niv treatment or receive the nasal high flow (nhf) treatment delivered by myairvo2 during 3 months nasal high-flow (nhf) is a treatment delivering heated, humidified, and optionally oxygen-enriched air at high flow rates through a nasal cannula. the main physiologic effects of nhf are an improvement in gas exchanges including a reduction in hypercapnia, an optimization in breathing patterns with a reduction of work of breathing. nasal high-flow (nhf) is delivered via a comfortable nasal interface and has demonstrated good treatment adherence. the investigators hypothesize that in copd-related hypercapnic chronic respiratory failure with limited compliance to niv (less than 5 hours per night), nasal high-flow (nhf) will be non-inferior for controlling nocturnal hypoventilation and might improve daytime subjective patients centered outcomes, physical activity and nocturnal adherence to treatment.

Eligibility criteria:
inclusion criteria: * diagnosed with copd (fev1/fvc \< 70%) and long term indication for home niv for initiated at least 3 months prior the inclusion. * compliance with niv (less than 5 hours and more than 1 hour) per night on average during the last 3 months prior to inclusion. * naïve to nasal high flow (nhf) therapy, i.e. having not used nhf in the last 6 months prior to inclusion. * able to understand, follow objectives and methods of protocol in french language. * patient affiliated to social security insurance or beneficiary of social health insurance. * willing and able to give written informed consent and to comply with the requirements of the study protocol. exclusion criteria: * significant uncontrolled cardiac disease (investigator judgment), and/or left ventricular ejection fraction (lvef) \< 45%. * known co-existing obstructive sleep apnea requiring expiratory pressure above 6 cmh20. * severe nasal obstruction, previous upper airway surgery preventing the usage of nhf, or, at the discretion of investigator, any other contraindication for using the nhf. * patients who are unable or unwilling to give informed consent. * participating in another research study. * patient protected by the law, under guardianship or curators. * pregnancy and nursing mothers * patient not covered by a health insurance.

Keywords: non-compliance niv nhf copd hypercapnic respiratory failure