Home High Flow Oxygen to Reduce Acute Exacerbation of COPD

Home High Flow Oxygen to Reduce Acute Exacerbation of COPD

The objective of the study is to evaluate the efficacy of home High Flow Oxygen for the reduction of severe exacerbation following admission for a severe exacerbation of COPD or death against standard oxygen therapy.

Inclusion Criteria:

1. Patient with a diagnosis of COPD defined by GOLD guidelines

2. Admitted in hospital for AECOPD

3. With severe respiratory impairment defined by one of the following criteria (long-term oxygen therapy (LTOT) criteria):

   • Previously established on long-term oxygen therapy according to the following criteria: PaO2 < 7.3kPa or <8kPa with polycythemia, pulmonary hypertension or right heart failure on room air in stable condition Or
   • PaO2 < 7.3kPa or <8kPa with polycythemia, pulmonary hypertension or right heart failure on room air after clinical stabilization during the index admission

4. Patients affiliated or, beneficiary of a social security cover

5. Patient who has read and understood the information letter and signed the consent form

6. For woman of childbearing potential, use of an effective contraception (oestro-progestatives or intra-uterine device or tubal ligation) since at least 1 month and an blood pregnancy test by β-HCG negative at the screening visit, during the duration of the study

7. For menopausal woman: confirmatory diagnosis (amenorrhea not medically induced for at least 12 months before the inclusion visit)

Exclusion Criteria:

1. Age <18 or > 85 years

2. Patient treated with chronic NIV with ongoing treatment

3. Patients diagnosed with obstructive sleep apnea (OSA) treated with CPAP. Diagnosis of OSA will be over-ruled in patient that had a previous overnight polygraphy. For patients who never had an overnight polygraphy, screening for OSA will be made using the STOP-BANG questionnaire. If the results of the STOP-BANG questionnaire (Appendix 1) is >3, an Apnea-link recording will be performed. If AHI>30/h, patient will be excluded.

4. BMI > 35 kg/m2

5. Patient admitted for an acute COVID-19 infection

6. Hypercapnic respiratory failure justifying NIV defined as

   1. An Arterial Blood Gas (ABG) PaCO2 > 7 kPa in stable condition within 6 months
   2. Patients with ABG PaCO2 > 7 kPa at hospital discharge and that remained hypercapnic between 2- and 4-weeks following discharge

7. Pregnancy (blood pregnancy test positive) or lactation ongoing

8. Significant psychiatric disorder or dementia that would prevent adherence to study protocol

9. Tobacco use < 10 pack-year

10. Expected survival < 12 months due to any situation other than COPD disease

11. Refusal of high-flow oxygen therapy

12. Person deprived of liberty by administrative or judicial decision or placed under judicial protection (guardianship or supervision)

13. Patients already involved in a research protocol that would impact with the outcome measured in the current protocol