The Efficacy of High Flow Nasal Cannula (HFNC) in Chronic Obstructive Pulmonary Disease (COPD): a Case Report

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a common chronic disease characterized by persistent airflow limitation, generally occurring in old age due to inhalation of harmful particles, such as smoking. Conventional oxygen therapy, High Flow Nasal Canula (HFNC), and Non-Invasive Ventilation (NIV) are important treatment strategies for acute exacerbation of COPD patients. COPD and COVID-19 share many potentially negative associations, which could lead to worse outcomes from COVID-19, including impaired lung function in older patients and the presence of co-morbidities. In addition, COPD patients may also be more susceptible to viral infections, including COVID-19.

METHOD

This was a retrospective case report, after analysis of patient clinical data. The patient provided written informed consent to publish their case details and any accompanying images.

CASE REPORT

A 63-year-old man was presented to being treated in hospital of Hasan Sadikin Hospital, with a complaint of shortness of breath that had been felt for two days before entering the hospital. This symptom was initially complained of after the patient returned home from gardening. Shortness of breath is not affected by weather and dust. He routinely treatment theophylline. The first day of treatment, the patient complained of increasingly severe shortness of breath accompanied by fever.

Figure 1. Hemodynamic Monitoring

Sensorium is compos mentis with normal blood pressure. Heart rate was 96 beat per minute (bpm), irregular rhythm, adequate volume with respiration rate was 26 times per minute and normal temperature. We found the Joffroy sign, Möbius sign, Stellwag sign, Von Graefe sign and Rosenbach sign from physical examination. Examination of thyroid gland showed symmetrical enlargement, unclear boundary, supple with no tender pain and no signs of inflammation. Mass was moved while swallowing, and no bruit was present. We found cardiomegaly and systolic murmur from heart examination. Thyroid hormone examination showed hyperthyroidism with FT4 and TSH were 56,63 ng/dl and TSHs <0,005 uU/ml respectively.

Chest X-ray resulted in cardiomegaly, as shown in Figure 1 below.

Figure 1. Chest X-Ray

During 4 days of hospitalization, the patient was admitted to the ICU because of worsening breathing and was given oxygen therapy with HFNC and other drugs for 8 days. Patient showed improvement and was then discharged after seven days of hospitalization.

DISCUSSION

The main factors of organ dysfunction in COPD patients and type II respiratory failure are respiratory acidosis, hypercapnia and hypoxemia. Emergency tracheal intubation is often performed during the course of treatment, and requires invasive ventilation. Oxygen therapy with HFNC is a type of therapy that can provide stable oxygen concentrations, increase mucosal clearance, prevent dead space in the nasopharynx and open alveoli, so it has good clinical value. Evidence emerged during the COVID-19 pandemic showing that implementing HFNC is feasible for treating patients with acute hypoxemic respiratory failure due to COVID-19 even with COPD.

Figure 1. Acute Respiratory Failure, Dead Space, Nasal High Flow, Respiratory Rate, Work Of Breathing

A meta-analysis study comparing HFNC with non-invasive ventilation (NIV), it turned out that HFNC was more useful in reducing PaCO2 values, length of hospital stay and incidence of facial and nasal skin damage, and there was no difference in effect on PaO2 values, incidence of tracheal intubation and mortality found between HFNC and NIV treatments. (Xu et al. Eur J Med Res (2021) 26: 122) Another meta-analysis study also showed no difference in PaO2 values ​​between patients treated with HFNC or NIV, but in a smaller study population. (Clin Respir J. 2021;15(4):437–44) Another study, has also compared HFNC and conventional NIV to evaluate the risk of death and intubation in acute COPD exacerbations in 8 RCTs and 492 patients, and produced evidence that HFNC does not increase the risk of death and intubation events. (Heart Lung. 2021;50(2):252–61)

In this patient, complaints of shortness of breath were found on admission, physical and supporting examinations were carried out, the patient was diagnosed with COPD accompanied by COVID-19. During 4 days of treatment in the room, the patient was admitted to the ICU because of worsening breathing  treated with HFNC and other drugs for 8 days. The patient improved, then moved to the usual inpatient room, and went home from the hospital 5 days later.

CONCLUSION

HFNC can be an alternative therapy in COPD therapy, because it has good tolerance and physiological effects, even compared to NIV there is no difference in the effect on PaO2 values, on the incidence of tracheal intubation and death during treatment.

DECLARATIONS

Ethics approval and consent to participate.

CONSENT FOR PUBLICATION

The Authors agree to publication in Journal of Society Medicine.

COMPETING INTERESTS

None.

AUTHORS’ CONTRIBUTIONS

All authors significantly contribute to the work reported, whether in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas. Contribute to drafting, revising, or critically reviewing the article. Approved the final version to be published, agreed on the journal to be submitted, and agreed to be accountable for all aspects of the work.

ACKNOWLEDGMENTS

Not applicable.

REFERENCE

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