Domiciliary high-flow in patients with severe COPD and chronic hypoxic failure: In whom can we reduce exacerbations

Nasal cannula delivered high-flow (HFNC) has previously been shown to reduce exacerbations (AECOPD) in patients with severe COPD and chronic hypoxic failure. This post hoc study investigates whether there are subgroups in whom HFNC would be of special value in terms of reduction of AECOPD. Method: In a 12 month randomized controlled trial 100 patients were randomized to HFNC . Poisson regression analysis was made to investigate the influence of: PCO2 and mMRC at baseline; AECOPD and number of hospital admissions (ADM) one year prior to inclusion, on the number of AECOPD in study, corrected for time of use of HFNC. Patients were subgrouped into 0-1 AECOPD 1 year prior to inclusion (N=32) vs ≥2 and 0-2 (N=51) vs ≥ 3. Poisson regression analysis was made for each subgroup to investigate the effect on the number of AECOPD in study, corrected for time of use. Results: Mean AECOPD 1 year pre study was 0.5(+/-0.5) in group 0-1, 4.54(+/-3) in group >2; at 12 months 1.5(+/-2) resp 3.55(+/-3). There was a significant correlation between AECOPD and ADM pre study and a reduction in number of exacerbations in study (p Conclusion: In patients with severe COPD and chronic hypoxic failure HFNC should be considered part of personalized medicine in patients with ≥2 exacerbations per year or previous COPD-related hospital admissions in order to reduce number of exacerbations.