What question did this study set out to answer?

To determine the effects of nasal high flow with expiratory flow relief on ventilation and patient comfort in COPD patients during acute exacerbation.

May 20, 2026

A44-26 Nasal High Flow With Expiratory Flow Relief: Effects on the Ventilation and Patient Comfort in COPD Patients During Acute Exacerbation

Key Points

To determine the effects of nasal high flow with expiratory flow relief on ventilation and patient comfort in COPD patients during acute exacerbation.
Nasal high flow delivered at 30 L/min and expiratory flow relief at 50 L/min in a crossover design
Thirty-minute application periods were randomly assigned to each patient
Ventilation and patient comfort were continuously monitored and recorded with specific parameters.
Both modes had similar effects on respiratory rate and ventilation; pCO2 decreased significantly while SpO2 improved
Median comfort scores were neutral to comfortable after each mode application with no negative impact from higher flow
Further reductions in pCO2 were noted with higher flow settings in the expiratory flow relief mode.

Abstract

Abstract Rationale Nasal High Flow (NHF) has become an established form of respiratory support in a broad range of patients. The asymmetrical cannula interface has been shown to accelerate the clearance of dead space in upper airways and increase positive airway pressure. Both effects are flow-dependent and contribute to the key physiological mechanisms of NHF. It is known that an increase of NHF rate is not always well-tolerated, particularly in patients with a lower breathing frequency. The study tested the hypothesis that expiratory flow relief (NHFrelief), which modulates the expiratory pressure profile without reducing its value at the end of expiration, can improve the tolerance of COPD patients to higher NHF settings without diminishing physiological benefits. Methods NHF at 30 L/min and NHFrelief at 50 L/min were delivered by AIRVO3 device and Optiflow Duet cannula interfaces (Fisher age 67.8±9.2; BMI 24.8±8.7; FEV1 36.4±14.9; pCO2 45.0±9.6; CAT 23.2±7.9; mMRC 3.2±1.2; Multidimensional Dyspnea Profile A1-Scale 5.1±2.9 of 10), NHF with both modes had a similar impact on respiratory rate and ventilation, while pCO2 and SpO2 also differed significantly between the phases (see Table 1). Both modes were equally rated with neutral (0) to comfortable (1), in Median: 1, SD 0.51 with no negative impact of the higher flow under NHFrelief. Conclusions In COPD exacerbation, NHF applied for 45 min reduced respiratory rate by prolonging both inspiratory and expiratory times and decreased pCO2, with a further reduction observed at the higher flow used in the expiratory flow relief mode. Both NHF 30 L/min and NHFrelief 50 L/min were similarly well tolerated. Further studies are needed to confirm these findings over a longer duration or during overnight application. This abstract is funded by: Fisher&Paykel Healthcare

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