HFO versus usual care in pulmonary rehabilitation of post-COPD-exacerbation patients

ABSTRACT

Introduction/Aim: Early pulmonary rehabilitation (PR) is guideline-recommended for all chronic obstructive pulmonary disease (COPD) patients post-hospitalization for COPD exacerbation but many patients cannot participate in early PR due to significant breathlessness. High flow nasal oxygen (HFO) has been shown to improve ventilatory efficiency in stable COPD patients, but there is little data on HFO use during exercise training in PR of COPD patients post-exacerbation. Method(s) We conducted a pilot randomized controlled trial (RCT) to explore the feasibility of a prospective large-scale RCT to evaluate the impact of HFO in improving PR outcomes of COPD patients post-exacerbation. Patients recently hospitalized for acute COPD exacerbation were enrolled and randomized to either HFO application or usual standard care during an early 6-week outpatient, twice-weekly pulmonary rehabilitation program. Result(s) 22 patients were randomized between May 2019 and December 2019 and 18 patients completed the study. 2 patients in the HFO arm and 1 patient in the usual care arm withdrew for reasons unrelated to the study. The 22 nd patient (HFO arm) ceased participation due to research restrictions at the COVID pandemic onset. The HFO arm achieved a greater improvement in exercise capacity than the usual care arm, with the mean difference in the 6-min walk distance (6MWD) between the two arms being 30 m (95% CI -23 to 84 m). All 18 patients in both arms were compliant to the pulmonary rehabilitation program (defined by attending >=75% of exercise sessions). HFO was well tolerated with no adverse events associated with its implementation. Conclusion(s) This RCT has shown preliminary evidence of the feasibility and high patient acceptability of HFO during early pulmonary rehabilitation on improving exercise capacity in COPD patients post-exacerbation These promising results would justify a larger RCT to confirm HFO's benefits and has the potential to change PR practice.