High-Flow in Hypercapnic Stable COPD Patients

NCT ID: NCT04281316

Last Updated: 2022-05-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

3 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-23

Study Completion Date

2021-12-16

Brief Summary

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Monocentric, prospective, open, randomized 1:1, controlled study to evaluate the impact of nasal high-flow (NHF) on nocturnal transcutaneous PCO2 (PtCO2) compared to non-invasive ventilation ± Long-Term Oxygen Therapy (LTOT) in patients with a Chronic obstructive pulmonary disease (COPD)-related hypercapnic respiratory failure.

Detailed Description

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Chronic obstructive pulmonary disease (COPD) is a growing global health concern, causing considerable health-related costs and increased mortality. COPD is nowadays considered a complex, heterogeneous and systemic condition.

In the late stage of the disease, non-invasive ventilation (NIV) is widely prescribed either to treat acute hypercapnic respiratory failure during COPD exacerbations or for long term home management.

A meta-analysis has shown that higher daytime PaCO2 occurred in home NIV treated COPD patients when NIV compliance is less than 5 h/day. Thus, an optimal NIV adherence is a key target for controlling nocturnal and diurnal hypoventilation and improving prognosis.

COPD is the clinical scenario during which a good NIV adherence is difficult to achieve. Particularly, in COPDs exhibiting hyperinflation, NIV can aggravate dynamic hyperinflation resulting in unrewarded inspiratory efforts, poor sleep and low NIV compliance. Alternatives to NIV are then desirable in this specific subgroup of hypercapnic COPD with poor adherence to NIV.

During this trial, stable COPD patients treated by long term home Non-Invasive Ventilation (NIV) treatment following French national recommendations and exhibiting a NIV compliance of (less than 5 hours and more than 1 hour) per day in the last 3 months prior to inclusion will be randomized via a secure electronic website to either continue with their current NIV treatment or receive the nasal high flow (NHF) treatment delivered by myAirvo2 during 3 months Nasal High-Flow (NHF) is a treatment delivering heated, humidified, and optionally oxygen-enriched air at high flow rates through a nasal cannula. The main physiologic effects of NHF are an improvement in gas exchanges including a reduction in hypercapnia, an optimization in breathing patterns with a reduction of work of breathing. Nasal High-Flow (NHF) is delivered via a comfortable nasal interface and has demonstrated good treatment adherence.

The investigators hypothesize that in COPD-related hypercapnic chronic respiratory failure with limited compliance to NIV (less than 5 hours per night), nasal High-Flow (NHF) will be non-inferior for controlling nocturnal hypoventilation and might improve daytime subjective patients centered outcomes, physical activity and nocturnal adherence to treatment.

Conditions

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Adherence, Treatment

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Non Invasive Ventilation device group

The patients in the NIV arm will receive treatment as in their usual care with an additional educational session of one hour for improving compliance.

Group Type ACTIVE_COMPARATOR

Non Invasive Ventilation

Intervention Type DEVICE

Participants randomized in the Non Invasive Ventilation group will receive treatment as in their usual care.

Education session

Intervention Type OTHER

Participants randomized in the Non Invasive Ventilation group will receive an additional educational session of one hour for improving compliance.

Nasal High Flow (MyAirvo) device group

The patients in the NHF arm will receive NHF treatment and two hours training adaptation session will be conducted in the hospital.

Group Type EXPERIMENTAL

Nasal High Flow installation

Intervention Type DEVICE

Participants randomized in NHF group will receive the nasal high flow (NHF) treatment delivered by myAirvo2.

Nasal High-Flow (NHF) is a treatment delivering heated, humidified, and optionally oxygen-enriched, air at high flow rates through a nasal cannula. The physiologic effects of NHF are an improvement in gas exchanges including a reduction in hypercarbia an optimization in breathing patterns with a reduction of work of breathing and high compliance as delivered via a comfortable nasal interface

Training session

Intervention Type OTHER

The patients in the Nasal High Flow (MyAirvo) arm will receive two hours training adaptation session in the hospital

Interventions

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Nasal High Flow installation

Participants randomized in NHF group will receive the nasal high flow (NHF) treatment delivered by myAirvo2.

Nasal High-Flow (NHF) is a treatment delivering heated, humidified, and optionally oxygen-enriched, air at high flow rates through a nasal cannula. The physiologic effects of NHF are an improvement in gas exchanges including a reduction in hypercarbia an optimization in breathing patterns with a reduction of work of breathing and high compliance as delivered via a comfortable nasal interface

Intervention Type DEVICE

Non Invasive Ventilation

Participants randomized in the Non Invasive Ventilation group will receive treatment as in their usual care.

Intervention Type DEVICE

Training session

The patients in the Nasal High Flow (MyAirvo) arm will receive two hours training adaptation session in the hospital

Intervention Type OTHER

Education session

Participants randomized in the Non Invasive Ventilation group will receive an additional educational session of one hour for improving compliance.

Intervention Type OTHER

Other Intervention Names

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MyAirvo Device

Eligibility Criteria

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Inclusion Criteria

* Diagnosed with COPD (FEV1/FVC \< 70%) and long term indication for home NIV for initiated at least 3 months prior the inclusion.
* Compliance with NIV (less than 5 hours and more than 1 hour) per night on average during the last 3 months prior to inclusion.
* Naïve to Nasal High Flow (NHF) therapy, i.e. having not used NHF in the last 6 months prior to inclusion.
* Able to understand, follow objectives and methods of protocol in French language.
* Patient affiliated to social security insurance or beneficiary of social health insurance.
* Willing and able to give written Informed Consent and to comply with the requirements of the study protocol.

Exclusion Criteria

* Significant uncontrolled cardiac disease (investigator judgment), and/or Left Ventricular Ejection Fraction (LVEF) \< 45%.
* Known co-existing obstructive sleep apnea requiring expiratory pressure above 6 cmH20.
* Severe nasal obstruction, previous upper airway surgery preventing the usage of NHF, or, at the discretion of investigator, any other contraindication for using the NHF.
* Patients who are unable or unwilling to give informed consent.
* Participating in another research study.
* Patient protected by the Law, under guardianship or curators.
* Pregnancy and nursing mothers
* Patient not covered by a health insurance.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Icadom

INDUSTRY

Sponsor Role collaborator

Fisher and Paykel Healthcare

INDUSTRY

Sponsor Role collaborator

University Hospital, Grenoble

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jean-Louis Pépin, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Laboratoire EFCR, CHU de Grenoble

Locations

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Grenoble Alpes University Hospital

Grenoble, , France

Site Status

Countries

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France

References

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Biener AI, Decker SL, Rohde F. Prevalence and Treatment of Chronic Obstructive Pulmonary Disease (COPD) in the United States. JAMA. 2019 Aug 20;322(7):602. doi: 10.1001/jama.2019.10241. No abstract available.

Reference Type BACKGROUND
PMID: 31429884 (View on PubMed)

Riley CM, Sciurba FC. Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease: A Review. JAMA. 2019 Feb 26;321(8):786-797. doi: 10.1001/jama.2019.0131.

Reference Type BACKGROUND
PMID: 30806700 (View on PubMed)

Houben-Wilke S, Augustin IM, Vercoulen JH, van Ranst D, Bij de Vaate E, Wempe JB, Spruit MA, Wouters EFM, Franssen FME. COPD stands for complex obstructive pulmonary disease. Eur Respir Rev. 2018 Jun 6;27(148):180027. doi: 10.1183/16000617.0027-2018. Print 2018 Jun 30.

Reference Type BACKGROUND
PMID: 29875138 (View on PubMed)

Suh ES, Murphy PB, Hart N. Home mechanical ventilation for chronic obstructive pulmonary disease: What next after the HOT-HMV trial? Respirology. 2019 Aug;24(8):732-739. doi: 10.1111/resp.13484. Epub 2019 Feb 7.

Reference Type BACKGROUND
PMID: 30729638 (View on PubMed)

Crimi C, Noto A, Princi P, Cuvelier A, Masa JF, Simonds A, Elliott MW, Wijkstra P, Windisch W, Nava S. Domiciliary Non-invasive Ventilation in COPD: An International Survey of Indications and Practices. COPD. 2016 Aug;13(4):483-90. doi: 10.3109/15412555.2015.1108960. Epub 2016 Jan 8.

Reference Type BACKGROUND
PMID: 26744042 (View on PubMed)

Kohnlein T, Windisch W, Wegscheider K, Welte T. Non-invasive positive pressure ventilation for severe COPD--Authors' reply. Lancet Respir Med. 2014 Oct;2(10):e19. doi: 10.1016/S2213-2600(14)70215-2. No abstract available.

Reference Type BACKGROUND
PMID: 25298063 (View on PubMed)

Murphy AM, Thomas A, Crinion SJ, Kent BD, Tambuwala MM, Fabre A, Pepin JL, Roche HM, Arnaud C, Ryan S. Intermittent hypoxia in obstructive sleep apnoea mediates insulin resistance through adipose tissue inflammation. Eur Respir J. 2017 Apr 19;49(4):1601731. doi: 10.1183/13993003.01731-2016. Print 2017 Apr.

Reference Type BACKGROUND
PMID: 28424360 (View on PubMed)

Vanfleteren LEGW, Spruit MA, Wouters EFM, Franssen FME. Management of chronic obstructive pulmonary disease beyond the lungs. Lancet Respir Med. 2016 Nov;4(11):911-924. doi: 10.1016/S2213-2600(16)00097-7. Epub 2016 Jun 2.

Reference Type BACKGROUND
PMID: 27264777 (View on PubMed)

Borel JC, Pepin JL, Pison C, Vesin A, Gonzalez-Bermejo J, Court-Fortune I, Timsit JF. Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients. Respirology. 2014 Aug;19(6):857-65. doi: 10.1111/resp.12327. Epub 2014 Jun 9.

Reference Type BACKGROUND
PMID: 24912564 (View on PubMed)

Struik FM, Lacasse Y, Goldstein RS, Kerstjens HA, Wijkstra PJ. Nocturnal noninvasive positive pressure ventilation in stable COPD: a systematic review and individual patient data meta-analysis. Respir Med. 2014 Feb;108(2):329-37. doi: 10.1016/j.rmed.2013.10.007. Epub 2013 Oct 14.

Reference Type BACKGROUND
PMID: 24157199 (View on PubMed)

Other Identifiers

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38R19.250

Identifier Type: -

Identifier Source: org_study_id

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