During-exercise Physiological Effects of Nasal High-flow in Patients With Chronic Obstructive Pulmonary Disease
Condition: Chronic Obstructive Pulmonary Disease
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Interventional

Summary: 
      Chronic obstructive pulmonary disease is a major cause of disability and mortality worldwide.
      This disease progressively leads to dyspnea and exercise capacity impairment. Pulmonary
      rehabilitation teaches chronic obstructive pulmonary disease patients to cope effectively
      with the systemic effects of the disease and improves exercise capacity, dyspnea and quality
      of life in patients with chronic obstructive pulmonary disease. However, the best training
      modality remains unknown. Physiological studies highlight the benefit of high intensity
      endurance training. However, many patients do not tolerate such a training due to ventilatory
      limitation and dyspnea. Therefore, a strategy to reduce dyspnea would allow a greater
      physiological muscle solicitation and improvement. Thus, many studies focus on means to
      increase exercise tolerance in patients with chronic obstructive pulmonary disease.

      Nasal high flow delivers heated and humidified high flow air (up to 60 L/min) through nasal
      cannula providing physiological benefits such as positive airway pressure and carbon dioxide
      washout. It can be used in association with oxygen and offers the advantage to overtake the
      patient's inspiratory flow, providing a stable inspired fraction of oxygen. Nasal high flow
      has widely been studied in pediatric and adult intensive care units and seems better than
      conventional oxygen therapy and as effective as noninvasive ventilation with regards to
      mortality to treat hypoxemic acute respiratory failure.

      More recently, nasal-high flow has been shown to improve endurance exercise capacity in
      patients with chronic obstructive pulmonary disease. However, the underlying physiological
      mechanisms have not been yet elucidated but may help to optimise the utilization of the
      device.

      Therefore, the primary objective of this study is to assess the respiratory physiological
      effects nasal high-flow during-exercise in stable patients with chronic obstructive pulmonary
      disease.

      Secondary objectives are to assess the effects nasal high-flow during-exercise on endurance
      capacity, respiratory drive, dynamic hyperinflation, cardiorespiratory pattern and muscular
      metabolism.
    

Detailed description: 
      Experimental design:

      Patients referred for pulmonary rehabilitation will be approached to participate in this
      study. Eligible patients who agree to participate in the study and sign informed consent will
      perform two constant workload exercise testing the same day with either nasal high-flow or
      sham nasal high-flow (separated by a 1 hour rest-period) in a randomized order.
    

Intervention name(s): Nasal high-flow; Sham nasal high-flow
Intervention type(s): Device; Other
Intervention description(s): See arm description.; See arm description.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Single-blind randomized cross-over study.
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Chronic obstructive pulmonary disease; Exercise; Nasal high flow; Muscle