Exploring the Role of High-Flow Nasal Cannula Therapy in Interstitial Lung Disease
A recent study evaluated the effects of high-flow nasal cannula (HFNC) therapy on exercise tolerance and oxygenation in patients with interstitial lung disease (ILD), revealing improvements with oxygen supplementation.
Interstitial lung disease is marked by dyspnea on exertion and exercise-induced hypoxemia, both of which limit patients’ quality of life and ability to engage in physical activity. HFNC therapy, which delivers high gas flow and oxygen supplementation, has shown potential to reduce respiratory workload and improve oxygenation. However, its specific impact on exercise tolerance in patients with ILD remained unclear.
This three-treatment crossover study involved 25 patients with ILD (10 men, mean age 71.2 ± 6.7 years) who completed constant-load cycle ergometry exercises under three conditions: room air (ROOM AIR, flow 0 L/min, FiO₂ 0.21), HFNC with high flow alone (FLOW, flow 40 L/min, FiO₂ 0.21), and HFNC with high flow plus oxygen supplementation (FLOW + OXYGEN, flow 40 L/min, FiO₂ 0.6). The primary outcome was exercise endurance time, measured at 80% of the peak work rate, with percutaneous oxygen saturation (SpO₂) recorded as a secondary measure.
Patients exhibited an increase in exercise endurance time with oxygen supplementation. The FLOW + OXYGEN setting extended exercise duration by 91.5 seconds compared with the FLOW setting (95% CI, 39.1-143.9; P < .001) and by 137.8 seconds compared with ROOM AIR (P < .001). Resting SpO₂ was highest with FLOW + OXYGEN and remained superior during exercise compared with ROOM AIR and FLOW settings. Additionally, the FLOW setting demonstrated improved SpO₂ compared with ROOM AIR at equivalent time points during exercise, although this did not translate to a statistically significant increase in endurance time (P = .083).
“Oxygen supplementation in HFNC therapy improved exercise tolerance and SpO₂,” the researchers concluded. “We found that gas flow alone did not improve exercise tolerance, but improved SpO₂ during exercise.”
Reference
Yanagita Y, Arizono S, Yokomura K, et al. Enhancing exercise tolerance in interstitial lung disease with high-flow nasal cannula oxygen therapy. Respirology. 2024;29(6):497-504. doi:10.1111/resp.14684