Home high-flow therapy

Nasal high-flow therapy consists of the active heated humidification of air/oxygen at high flows, which is administered through a heated inspiratory circuit with nasal cannula.
High-flow therapy can be administered in different ways. On this page, we refer exclusively to nasal high-flow therapy.

How does home high-flow therapy work?

High-flow therapy (HFT) is designed to be administered via a nasal high flow cannula (NHFC) which delivers a heated, humidified mixture of air and oxygen warmed to between 31°C and 37°C.

Home HFT can supply flow rates ranging between 10 L/min to 60L/min.

If oxygen is added, it can be delivered at up to 15 L/min and the configuration used depends on the need of the patient.

 

High-flow mechanisms of action:

High-flow therapy can improve breathing through different effects on:

  • Mucociliary clearance and secretion management1
  • Dyspnoea during high-intensity exercise2-4
  • Work of breathing 5

High-flow therapy is also associated with patients benefits such as:

  • Improved comfort and quality of life6,7
  • Reduced acute exacerbations of COPD & rates of hospital admission6,7

 

Who can benefit from high-flow therapy?

High-flow therapy could be indicated for domiciliary use in COPD patients affected by chronic cough with mucous production.1,6

 

When can high-flow therapy be used?

High-flow therapy can be used at home during the day or at night. Patients can talk, eat, and sleep while using therapy. Due to the water contained in the heated humidifier, the device must be moved carefully. Patients can place their therapy device on a stable surface and continue to enjoy day-to-day activities, such as reading and watching TV.

 

Why prescribe high-flow therapy above other available therapies?

High-flow therapy does not replace oxygen therapy but helps patients improve secretion management as well as providing positive effects on breathing.1

 

Which high-flow therapy units are available?

The key components of high-flow therapy (HFT) units comprise: an air/oxygen mix (with or without blender), a flow generator, heater, humidifier, warmed inspiratory circuit (to prevent condensation) and, in the case of nasal HFT, a soft non-occluding nasal cannula.

HFT is suited to a home therapy setting. Home devices do not require a high-pressure wall oxygen supply, the blower is located on the inside, and the design facilitates easy operation and training for home use.

Some HFT machines are also suitable for remote monitoring.

Home high-flow therapy FAQs

High flow therapy can be configured to be delivered with or without additional oxygen, depending on the needs of the patient. Oxygen can be added at flow rates of up to 15 L/min.

Yes. High-flow therapy systems have been designed for home use. They do not require a high-pressure wall oxygen supply, the blower is located on the inside, and the design facilitates easy operation and training for home use.

Domiciliary high-flow therapy can be used during the day and/or at night. Usage hours vary depending on the needs and condition of the patient.

COPD patients who use oxygen benefit from the mucous clearance potential in particular, along with other effects of high-flow therapy. More details can be found here.

No, it can be considered as a complementary therapy depending of the patient need.

Generally, no, as it does not provide ventilation or pressure support. It can, however, benefit the hypercapnic patient group through use in between NIV therapy by adding more comfort during time off NIV.9

HFT does not provide ventilation or pressure support for patients with failure of their respiratory system. Learn more about mechanical ventilation here and on CPAP here

HFT consists of an adjustable flow of 15-60L/min and a temperature of 31-37°C. In addition, for comfort and condensation management, the humidification level can be adjusted.

Evidence suggests that effects are noticeable from >1-2h usage duration.6,7 Potential benefits could be realised from using high-flow therapy for as long as possible.

Another trial has shown that usage of around 6 hours, mostly during the night, is suitable.6

Yes​, high-flow therapy can be used while a patient is both sleeping and awake.

Yes. Flows and humidification have a positive peak inspiratory flow effect and oxygen is delivered more effectively, which is important during exercise.3​ This improves dyspnoea during exercise.2-4 Due to the water contained in the heated humidifier, the device must be moved carefully during exercise.8

Noise levels will depend on the device and flow.

Humidification has a major role in conditioning the gases as oxygen is very cold and dry. ​

Non contractual picture of the nasal cannula – Use only nasal cannulas recommended by ResMed.

References:

  1. Hasani A, et al. Domiciliary humidification improves lung mucociliary
    clearance in patients with bronchiectasis. Chron Respir Dis 2008;5:81-86.
  2. Cirio S, Piran M, Vitacca M, Piaggi G, Ceriana P, Prazzoli M, et al. Effects of heated and humidified high flow gases during high-intensity constant load exercise on severe COPD patients with ventilatory limitation. Respiratory Medicine 2016;118:128–32.
  3. Neunhäuserer D, Steidle-Kloc E, Weiss G, Kaiser B, Niederseer D, Hartl S, et al. Supplemental Oxygen During High-Intensity Exercise Training in Nonhypoxemic Chronic Obstructive Pulmonary Disease. The American Journal of Medicine 2016;129(11):1185–93.
  4. Chatila W, Nugent T, Vance G, Gaughan J, Criner GJ. The Effects of High- Flow vs Low-Flow Oxygen on Exercise in Advanced Obstructive Airways Disease. Chest 2004;126(4):1108–15.
  5. Fraser JF, et al. Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: a randomised crossover trial. Thorax 2016;71:759-761.
  6. Storgaard LH, et al. Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure. Int J Chron Obstruct Pulmon Dis 2018;13:1195-1205.
  7. Rea H, et al. The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med 2010;104:525-533.
  8. Nagata K, Kikuchi T, Horie T, Shiraki A, Kitajima T, Kadowaki T, et al. Domiciliary High-Flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD Patients: A Multicenter, Randomized Crossover Trial. Annals of the American Thoracic Society. 2017.
  9. Spoletini G, Mega C, Pisani L, Alotaibi M, Khoja A, Price LL, Blasi F, Nava S, Hill NS. High-flow nasal therapy vs standard oxygen during breaks off noninvasive ventilation for acute respiratory failure: A pilot randomized controlled trial. J Crit Care. 2018 Dec;48:418-425. doi: 10.1016/j.jcrc.2018.10.004. Epub 2018 Oct 5. PMID: 30321833.
[Patient Name]
[Patient Name]
[XXX-XXX-XXXX]
[XXX-XXX-XXXX]
[EMAIL]
[EMAIL]
[DAYS AND TIMES]
[DAYS AND TIMES]
[YOUR CLINIC / NAME]
[YOUR CLINIC / NAME]