Effect of high fraction of inspired oxygen and high flow on exercise tolerance in patients with COPD and IPF: A randomized crossover trial

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation Pub Date : 2025-04-01 DOI:10.1016/j.resinv.2025.03.016

Yuichi Chihara, Tomomasa Tsuboi, Kensuke Sumi, Hiromasa Tachibana, Atsuo Sato

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Abstract

Background

The effect of combining high fraction of inspired oxygen (F_IO₂) and high flow through a high-flow nasal cannula (HFNC) on exercise tolerance in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) remains unclear.

Methods

This prospective, single-blind, randomized, crossover study included patients with COPD (n = 25) and IPF (n = 25). The patients performed a 6-min walking test (6 MWT) while attached to a battery-supplied portable HFNC device under the following four conditions: F_IO₂ set to a minimum percutaneous oxygen saturation (SpO₂) of 86–88 % during 6 MWT with a flow rate of 10 L/min (LOLF) or 50 L/min (LOHF); and F_IO₂ set to a minimum SpO₂ of 92–94 % with a flow rate of 10 L/min (HOLF) or 50 L/min (HOHF).

Results

In both groups, the 6-min walking distance (6 MWD) was significantly greater for HOHF than for LOLF (COPD: 323.2 ± 77.6 m vs. 268.6 ± 87.3 m, respectively, p < 0.0001 and IPF: 406 ± 50.7 m vs. 372.3 ± 50.9 m, respectively, p < 0.0001).

In the analysis of the interaction effects for the 6 MWD, the combination of high F_IO₂ and high flow resulted in an additional 15.9-m extension of the 6 MWD (95 % confidence interval: 0.34–31.5; p = 0.050). The interaction between IPF and high-flow was −14.0 m, suggesting a less pronounced extension effect compared with COPD (95 % confidence interval: −29.5–1.6; p = 0.085).